Department of Medical Oncology, Allegheny Health Network Cancer Institute, Allegheny General Hospital, Level 01, 320 E. North Avenue, Pittsburgh, PA, 15212, USA.
Department of Radiation Oncology, Allegheny Health Network, Cancer Institute Pittsburgh, Pa, USA.
J Gastrointest Cancer. 2022 Sep;53(3):700-708. doi: 10.1007/s12029-021-00696-w. Epub 2021 Sep 6.
Each year, approximately 8000 cases of cholangiocarcinoma are recorded in the USA. Surgical resection is considered to be the only curative option. Despite surgery as a curative approach, many patients will require adjuvant therapies in the form of chemotherapy (ChT) or chemoradiotherapy (CRT). As such, we sought to analyze outcomes in patients with non-metastatic cholangiocarcinoma receiving adjuvant ChT or CRT following surgical resection.
We queried the National Cancer Database (NCDB) for patients with a diagnosis of non-metastatic cholangiocarcinoma between the years 2010 and 2015 who underwent adjuvant ChT or CRT following surgery. Overall survival (OS) was calculated using Kaplan Meier method. Cox proportional hazard ratios were used to identify predictors of overall survival, and logistic regression was used to identify predictors of receiving each treatment.
A total of 875 patients were identified who met the above eligibility criteria. Of these patients, 818 received adjuvant chemotherapy alone with 57 patients receiving adjuvant chemoradiation therapy. The median OS in patients receiving CRT was 19.8 months versus 11.9 months for ChT (p value < 0.0238). The 1- and 5-year survival rates between ChT and CRT were 50% vs 61% and 6% vs 13%, respectively (hazard ratio 0.7005; 95% CI 0.51-0.97; p value < 0.0294).
The results of this study suggest a potential benefit of chemoradiation therapy in the adjuvant setting, although the trends appear to show rare utilization. Given the limitations of our study, prospective corroboration is warranted.
在美国，每年约有 8000 例胆管癌病例被记录。手术切除被认为是唯一的治愈方法。尽管手术是一种治愈方法，但许多患者仍需要辅助治疗，包括化疗（ChT）或放化疗（CRT）。因此，我们旨在分析接受手术切除后接受辅助 ChT 或 CRT 的非转移性胆管癌患者的结局。
我们从国家癌症数据库（NCDB）中查询了 2010 年至 2015 年期间诊断为非转移性胆管癌并在手术后接受辅助 ChT 或 CRT 的患者。使用 Kaplan-Meier 方法计算总生存期（OS）。Cox 比例风险比用于确定总生存期的预测因素，逻辑回归用于确定接受每种治疗的预测因素。
共确定了 875 名符合上述入选标准的患者。这些患者中，818 名患者接受了单独的辅助化疗，57 名患者接受了辅助放化疗。接受 CRT 的患者的中位 OS 为 19.8 个月，而接受 ChT 的患者为 11.9 个月（p 值 < 0.0238）。ChT 和 CRT 组的 1 年和 5 年生存率分别为 50% vs 61%和 6% vs 13%（风险比 0.7005；95%CI 0.51-0.97；p 值 < 0.0294）。
这项研究的结果表明，放化疗在辅助治疗中可能具有潜在益处，尽管趋势似乎表明其应用较少。鉴于本研究的局限性，需要前瞻性证实。
