Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
J Surg Oncol. 2023 Jan;127(1):90-98. doi: 10.1002/jso.27112. Epub 2022 Oct 4.
Evidence for neoadjuvant therapy (NAT) in extrahepatic cholangiocarcinoma (eCCA) is limited. Our objectives were to: (1) characterize treatment trends, (2) identify factors associated with receipt of NAT, and (3) evaluate associations between NAT and postoperative outcomes.
Retrospective cohort study of the National Cancer Database (2004-2017). Multivariable logistic regression assessed associations between NAT and postoperative outcomes. Stratified analysis evaluated differences between surgery first, neoadjuvant chemotherapy, and neoadjuvant chemoradiation (CRT).
Among 8040 patients, 417 (5.2%) received NAT. NAT increased during the study period 2.9%-8.4% (p < 0.001). Factors associated with receipt of NAT included age <50 (vs. >75, odds ratio [OR] 4.32, p < 0.001) and stage 3 disease (vs. 1, OR 1.68, p = 0.01). Compared with surgery first, patients who received NAT had higher odds of R0 resection (OR 1.49, p = 0.01) and lower 30-day mortality (OR 0.51, p = 0.04). On stratified analysis, neoadjuvant chemotherapy was not associated with differences in any outcomes. However, neoadjuvant CRT was associated with improvement in R0 resection (OR 3.52, <0.001) and median survival (47.8 vs. 25.3 months, log-rank < 0.001) compared to surgery first.
NAT, particularly neoadjuvant CRT, was associated with improved postoperative outcomes. These data suggest expanding the use of neoadjuvant CRT for eCCA.
辅助治疗（NAT）在外周性胆管癌（eCCA）中的证据有限。我们的目的是：（1）描述治疗趋势，（2）确定与接受 NAT 相关的因素，以及（3）评估 NAT 与术后结果之间的关系。
对国家癌症数据库（2004-2017 年）进行回顾性队列研究。多变量逻辑回归评估了 NAT 与术后结果之间的关系。分层分析评估了先手术、新辅助化疗和新辅助放化疗（CRT）之间的差异。
在 8040 名患者中，有 417 名（5.2%）接受了 NAT。在研究期间，NAT 的使用率从 2.9%增加到 8.4%（p<0.001）。与接受 NAT 相关的因素包括年龄<50 岁（与>75 岁相比，比值比 [OR] 4.32，p<0.001）和 3 期疾病（与 1 期相比，OR 1.68，p=0.01）。与先手术相比，接受 NAT 的患者有更高的 R0 切除率（OR 1.49，p=0.01）和更低的 30 天死亡率（OR 0.51，p=0.04）。分层分析显示，新辅助化疗与任何结局均无差异相关。然而，与先手术相比，新辅助 CRT 与 R0 切除率的提高（OR 3.52，<0.001）和中位生存时间（47.8 与 25.3 个月，对数秩检验<0.001）相关。
NAT，特别是新辅助 CRT，与术后结果的改善相关。这些数据表明，在外周性胆管癌中扩大使用新辅助 CRT。
