Goktas Aydin Sabin, Cakan Demirel Burcin, Bilici Ahmet, Topcu Atakan, Aykan Musa Barış, Kahraman Seda, Akbıyık Ilgın, Atci Muhammed Mustafa, Olmez Omer Fatih, Yaren Arzu, Sendur Mehmet Ali Nahit, Geredeli Caglayan, Seker Mesut, Urun Yuksel, Karadurmus Nuri, Aydin Ahmet
Medical Faculty, Department of Medical Oncology, Istanbul Medipol University, Istanbul, Turkey.
Medical Faculty, Department of Medical Oncology, Pamukkale University Hospital, Denizli, Turkey.
Curr Med Res Opin. 2022 Oct;38(10):1751-1758. doi: 10.1080/03007995.2022.2108619. Epub 2022 Aug 16.
Advanced-stage biliary tract cancers (BTC) are rare malignancies with poor prognosis. There are few prospective trials, but several retrospective studies regarding treatment options. In this study, we aimed to investigate the role of systemic inflammatory parameters (SIP) and other possible independent factors that may affect survival and treatment approaches and to determine the benefit of later-line treatments in these patients.
A total of 284 patients, initially diagnosed with advanced stage or progressed after curative treatment of BTC, from different oncology centers in Turkey were included in this retrospective study. The prognostic significance of clinicopathological factors, SIPs and treatment options was analyzed.
At a median follow-up of 13 months, the median progression-free survival (PFS) was 6.1 months (95% CI:5.51-6.82), and the median overall survival (OS) time was 16.8 months (95% CI: 13.9-19.6). Treatment choice ( < .001 HR:0.70 CI95% 0.55-0.9), performance status ( < .001 HR:2.74 CI 95% 2.12-3.54) and neutrophil-to-lymphocyte ratio (NLR) ( = .02 HR:1.38 CI 95% 1.03-1.84) were independent prognostic factors for PFS. For OS, the independent prognostic indicators were determined as The Eastern Cooperative Oncology Group Performance Status (ECOG PS) ( < .001 HR:1.78 CI 95% 1.5-2.3), Systemic Immune-inflammation Index (SII) ( < .001 HR:0.51 CI95% 0.36-0.73) and stage at diagnosis ( = .002 HR:1.79 CI 95% 1.24-2.59). Furthermore, second and third line treatments significantly prolonged OS in advanced BTC ( < .001 HR:0.55 CI 95% 0.38-0.79; = .007 HR:0.51 CI95% 0.31-0.83, respectively).
SII and NLR are useful prognostic factors and may be helpful in making treatment decisions. Additionally, second and later-line treatments in advanced BTC have a significant impact on survival under real-life conditions.
晚期胆管癌（BTC）是一种预后较差的罕见恶性肿瘤。前瞻性试验较少，但有几项关于治疗方案的回顾性研究。在本研究中，我们旨在探讨全身炎症参数（SIP）和其他可能影响生存及治疗方法的独立因素的作用，并确定这些患者接受后线治疗的益处。
本回顾性研究纳入了来自土耳其不同肿瘤中心的284例患者，这些患者最初被诊断为晚期BTC或在BTC根治性治疗后病情进展。分析了临床病理因素、SIP和治疗方案的预后意义。
中位随访13个月时，中位无进展生存期（PFS）为6.1个月（95%CI：5.51 - 6.82），中位总生存期（OS）为16.8个月（95%CI：13.9 - 19.6）。治疗选择（<.001，HR：0.70，CI95% 0.55 - 0.9）、体能状态（<.001，HR：2.74，CI 95% 2.12 - 3.54）和中性粒细胞与淋巴细胞比值（NLR）（=.02，HR：1.38，CI 95% 1.03 - 1.84）是PFS的独立预后因素。对于OS，独立预后指标确定为东部肿瘤协作组体能状态（ECOG PS）（<.001，HR：1.78，CI 95% 1.5 - 2.3）、全身免疫炎症指数（SII）（<.001，HR：0.51，CI95% 0.36 - 0.73）和诊断时的分期（=.002，HR：1.79，CI 95% 1.24 - 2.59）。此外，二线和三线治疗显著延长了晚期BTC患者的OS（<.001，HR：0.55，CI 9
