Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.
Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou, China.
Cancer Med. 2020 Apr;9(8):2674-2685. doi: 10.1002/cam4.2925. Epub 2020 Feb 19.
The prognosis of intrahepatic cholangiocarcinoma (ICC) after radical resection is far from satisfactory; however, the clinical value of adjuvant therapy (AT) remains controversial. This multicenter study aimed to evaluate the clinical value of AT and identify potential patients who would be benefited from AT.
Data from ICC patients who underwent radical resection were retrospectively collected from 12 hepatobiliary centers in China between December 2012 and December 2015. Patients were divided into AT and non-AT groups based on whether AT was administered or not. Overall survival (OS) and disease-free survival (DFS) were analyzed using the Kaplan-Meier method before and after 1:2 propensity score matching (PSM). Subgroup analyses were conducted based on the established staging systems.
A total of 412 patients were enrolled in this study, and 77 patients (18.9%) received AT, including 32 (7.8%) patients who received transarterial chemoembolization (TACE), 21 (5.1%) patients who received chemotherapy, 10 (2.4%) patients who received radiotherapy, and 14 (3.4%) patients who received adjuvant chemoradiotherapy. The median OS and DFS were both longer in the AT group than in the non-AT group (43.0 months vs 21.0 months, P = .015; 16.0 months vs 11.0 months, P = .045, respectively), and the advantage of AT was confirmed for both the OS and DFS (P = .023; P = .046, respectively) after 1:2 PSM. Furthermore, based on the established nomogram, only "middle-risk" patients receiving AT cherished a longer median OS (43.0 months vs 20.0 months, P = .033). In subgroup analyses that were stratified by different AT strategies, patients receiving postoperative chemotherapy had a longer median OS (37.0 months vs 21.0 months, P = .039), while patients receiving postoperative TACE had a longer median DFS (50.0 months vs 11.0 months, P = .007).
With the current data, we conclude that AT benefits ICC patients following radical resection, especially those "middle-risk" patients, as evaluated by the established nomogram. However, exactly which patients are the most suitable for AT requires further study and validation.
根治性切除术后肝内胆管癌（ICC）的预后仍不理想；然而，辅助治疗（AT）的临床价值仍存在争议。本多中心研究旨在评估 AT 的临床价值，并确定可能从 AT 中获益的潜在患者。
回顾性收集 2012 年 12 月至 2015 年 12 月期间中国 12 家肝胆中心接受根治性切除术的 ICC 患者的数据。根据是否接受 AT，将患者分为 AT 组和非 AT 组。采用 Kaplan-Meier 法在 1：2 倾向评分匹配（PSM）前后分析总生存（OS）和无病生存（DFS）。根据既定分期系统进行亚组分析。
本研究共纳入 412 例患者，77 例（18.9%）接受 AT，包括 32 例（7.8%）接受经动脉化疗栓塞术（TACE）、21 例（5.1%）接受化疗、10 例（2.4%）接受放疗和 14 例（3.4%）接受辅助放化疗。AT 组的中位 OS 和 DFS 均长于非 AT 组（43.0 个月比 21.0 个月，P=0.015；16.0 个月比 11.0 个月，P=0.045），且 1：2 PSM 后 OS 和 DFS 的 AT 优势均得到证实（P=0.023；P=0.046）。此外，根据既定的列线图，仅接受 AT 的“中危”患者中位 OS 更长（43.0 个月比 20.0 个月，P=0.033）。在不同 AT 策略的亚组分析中，接受术后化疗的患者中位 OS 更长（37.0 个月比 21.0 个月，P=0.039），而接受术后 TACE 的患者中位 DFS 更长（50.0 个月比 11.0 个月，P=0.007）。
根据目前的数据，我们得出结论，辅助治疗有利于根治性切除术后的 ICC 患者，特别是根据既定列线图评估的“中危”患者。然而，哪些患者最适合 AT 需要进一步研究和验证。
