Division of Surgical Oncology, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.
Department of Gastrointestinal Oncology, Moffitt Cancer Center, Tampa, FL, USA.
Surg Oncol. 2020 Sep;34:298-303. doi: 10.1016/j.suronc.2020.06.004. Epub 2020 Jun 30.
Lymph node-positive biliary tract cancers have poor overall survival. Surgical resection followed by systemic chemotherapy is the mainstay of treatment. We sought to assess the delivery of multimodality therapy in the United States.
The Surveillance, Epidemiology, and End Results program database was used to identify patients with node-positive biliary tract cancers without distant metastases from 2000 to 2014. Patients were stratified by disease subtype (gallbladder cancer, intrahepatic, extrahepatic, or hilar cholangiocarcinoma) and treatment received (surgery alone, chemotherapy alone, or surgery + chemotherapy). Survival was analyzed using the Kaplan-Meier method and Cox proportional hazard modeling.
A total of 3226 patients with node-positive biliary tract cancers were identified. Of 2837 patients who underwent surgical resection, 1386 (49%) received no systemic chemotherapy following surgery, while 1451 (51%) received surgery + chemotherapy. A total of 389 patients (12%) received chemotherapy alone. Median overall survival was longer for patients who underwent surgery + chemotherapy (19 months, p < 0.0001). There was no difference in survival for those who received surgery alone versus chemotherapy alone (10 months for both, p = NS). Receipt of surgery + chemotherapy was independently associated with survival on Cox proportional hazard ratio modeling compared to surgery alone (HR for mortality 1.71, 95% CI 1.56-1.87, p < 0.0001) or chemotherapy alone (HR 1.68, 95% CI 1.46-1.92, p < 0.0001). These trends were consistent across all disease subtypes.
Optimal survival for node-positive biliary tract cancers depends on multimodality therapy. Following surgery, a substantial proportion of patients do not receive guideline recommended adjuvant therapy.
淋巴结阳性胆道癌患者的总体生存率较差。手术切除联合全身化疗是主要的治疗方法。我们旨在评估美国多模式治疗的实施情况。
利用监测、流行病学和最终结果（SEER）数据库，从 2000 年至 2014 年确定无远处转移的淋巴结阳性胆道癌患者。根据疾病亚型（胆囊癌、肝内、肝外或肝门部胆管癌）和接受的治疗（单纯手术、单纯化疗或手术+化疗）对患者进行分层。采用 Kaplan-Meier 法和 Cox 比例风险模型分析生存情况。
共确定了 3226 例淋巴结阳性胆道癌患者。在接受手术切除的 2837 例患者中，有 1386 例（49%）在手术后未接受任何全身化疗，而 1451 例（51%）接受了手术+化疗。共有 389 例（12%）患者接受单纯化疗。接受手术+化疗的患者中位总生存期较长（19 个月，p<0.0001）。单独接受手术或化疗的患者生存时间无差异（均为 10 个月，p=NS）。与单独手术相比，Cox 比例风险模型分析显示，接受手术+化疗与生存相关（死亡风险比为 1.71，95%CI 1.56-1.87，p<0.0001），与单独化疗相比（死亡风险比为 1.68，95%CI 1.46-1.92，p<0.0001）。这些趋势在所有疾病亚型中均一致。
淋巴结阳性胆道癌患者的最佳生存取决于多模式治疗。手术后，相当一部分患者未接受指南推荐的辅助治疗。
