Liang Hui, Wang Yifan, Chen Jie, Xing Jiajun, Pu Yabin
Department of General Surgery, Naval Medical Center of PLA, Shanghai, China.
Department of Cardiothoracic Surgery, Naval Medical Center of PLA, Shanghai, China.
Front Oncol. 2020 Dec 18;10:616170. doi: 10.3389/fonc.2020.616170. eCollection 2020.
Although the performance of adjuvant chemoradiotherapy (ACRT) for resected gallbladder cancer may improve the survival for certain patients, its impact on the survival in early-stage resected gallbladder adenocarcinoma (GBAC) patients remains underexplored. This study aimed to determine the ACRT effects on the survival of early-stage resected GBAC patients.
Patients with early-stage resected GBAC diagnosed between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The covariables included gender, age, race, tumor differentiation, TNM stage (AJCC TNM staging system, 7 edition), adjuvant radiotherapy (ART), and adjuvant chemotherapy (ACT). The effects of ACRT on survival were evaluated by univariate and multivariate analysis.
A total of 1,586 patients with resected GBAC met the inclusion criteria were included in this study. Patients who received ACT were older, with poorer tumor differentiation or higher TNM stage (all p < 0.05), while patients who underwent ART were proved to be significantly correlated with poorer tumor differentiation (p = 0.010) and higher TNM stage (p < 0.001). Univariate and multivariate analysis of overall survival (OS) showed that age (p < 0.001; HR, 2.039; 95% CI, 1.718-2.420), tumor grade (p < 0.001; HR, 1.887; 95% CI, 1.530-2.370), and AJCC 7th TNM stage (p < 0.001; HR, 1.417; 95% CI, 1.182-1.699) were independent prognostic risk factors. Interestingly, ART and ACT were not independently associated with improved OS in the overall cohort analysis. However, when patients were subgrouped according to tumor differentiation, ART (p = 0.049; HR, 0.639; 95% CI, 0.409-0.999) has been identified as a significant prognostic factor for grade III/IV patients. Meanwhile, ARC (p = 0.011; HR, 0.739; 95% CI, 0.586-0.932) was associated with improved OS among tumor stage II patients (p<0.001).
ACRT may have specific survival benefits for early-stage resected GBAC patients. ART can improve survival in patients with poor or absent tumor differentiation. Besides, patients with tumor invasion beyond muscularis (stage II tumor) may benefit from ACT. Our study provides supporting evidence for the clinical applications of ACRT in early-stage GBAC patients.
尽管辅助放化疗（ACRT）对胆囊癌切除术后患者的生存可能有改善作用，但对早期胆囊腺癌（GBAC）切除术后患者生存的影响仍未得到充分研究。本研究旨在确定ACRT对早期GBAC切除术后患者生存的影响。
从监测、流行病学和最终结果（SEER）数据库中选取2010年至2016年间诊断为早期GBAC切除术后的患者。协变量包括性别、年龄、种族、肿瘤分化程度、TNM分期（美国癌症联合委员会TNM分期系统，第7版）、辅助放疗（ART）和辅助化疗（ACT）。通过单因素和多因素分析评估ACRT对生存的影响。
本研究共纳入1586例符合纳入标准的GBAC切除术后患者。接受ACT的患者年龄较大，肿瘤分化较差或TNM分期较高（均p<0.05），而行ART的患者被证明与较差的肿瘤分化（p = 0.010）和较高的TNM分期（p<0.001）显著相关。总生存（OS）的单因素和多因素分析显示，年龄（p<0.001；HR，2.039；95%CI，1.718 - 2.420）、肿瘤分级（p<0.001；HR，1.887；95%CI，1.530 - 2.370）和美国癌症联合委员会第7版TNM分期（p<0.001；HR，1.417；95%CI，1.182 - 1.699）是独立的预后危险因素。有趣的是，在总体队列分析中，ART和ACT与OS改善无独立相关性。然而，当根据肿瘤分化对患者进行亚组分析时，ART（p = 0.049；HR，0.639；95%CI，0.409 - 0.999）被确定为III/IV级患者的显著预后因素。同时，ACRT（p = 0.
