Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, People's Republic of China.
Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University, People's Republic of China.
HPB (Oxford). 2019 Nov;21(11):1535-1540. doi: 10.1016/j.hpb.2019.03.369. Epub 2019 May 2.
The role of adjuvant radiotherapy for resected ampullary carcinoma (AC) remains controversial. The aim of this study was to assess the effect of adjuvant radiotherapy on survival in patients who underwent resection for AC.
The Surveillance, Epidemiology and End Results (SEER) database was used to identify patients diagnosed with AC from 2004 to 2012. Kaplan-Meier survival curve and multivariable Cox proportional hazards analyses were conducted to determine the effect of adjuvant radiotherapy on overall survival (OS) and disease-specific survival (DSS). Propensity score matching (PSM) method was used to balance the differences of clinicopathological characteristics between groups.
A total of 1227 patients were included. Patients who received adjuvant radiotherapy were younger, had more advanced T stage and N stage tumors and were more likely to receive chemotherapy (p < 0.001). Adjuvant radiotherapy failed to improve either OS (p = 0.119) or DSS (p = 0.188) in PSM cohorts. In subgroup analysis, no subgroup benefited from adjuvant radiotherapy and in patients older than 70 years, radiotherapy was associated with a worse OS and DSS.
Patients with resected AC do not benefit from adjuvant radiotherapy.
辅助放疗在切除的壶腹癌（AC）中的作用仍存在争议。本研究旨在评估辅助放疗对接受 AC 切除的患者生存的影响。
使用监测、流行病学和最终结果（SEER）数据库，从 2004 年至 2012 年确定诊断为 AC 的患者。采用 Kaplan-Meier 生存曲线和多变量 Cox 比例风险分析，确定辅助放疗对总生存（OS）和疾病特异性生存（DSS）的影响。采用倾向评分匹配（PSM）方法平衡组间临床病理特征的差异。
共纳入 1227 例患者。接受辅助放疗的患者年龄较小，肿瘤的 T 分期和 N 分期较晚，且更有可能接受化疗（p<0.001）。PSM 队列中，辅助放疗未能改善 OS（p=0.119）或 DSS（p=0.188）。亚组分析显示，辅助放疗没有使任何亚组获益，而且对于 70 岁以上的患者，放疗与较差的 OS 和 DSS 相关。
接受切除的 AC 的患者不能从辅助放疗中获益。
