Sun Zhongquan, Han Xin, You Wanlu, Tang Jinlong, Xu Juehua, Ye Binglin, Li Tengfei, Zhang Yixin, Chen Kai, Ding Yuan, Wang Weilin
Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang, China.
Front Oncol. 2023 Mar 17;13:1116338. doi: 10.3389/fonc.2023.1116338. eCollection 2023.
Cholangiocarcinoma (CCA) is a highly heterogeneous malignant tumor, and more than 60% of patients have recurrence and metastasis after surgery. The efficacy of postoperative adjuvant therapy for CCA remains unclear. This study aimed to explore whether adjuvant therapy benefits patients with CCA and examine the independent prognostic factors for overall survival (OS) and progression-free survival (PFS).
Patients with CCA undergoing surgery were retrospectively enrolled in this study from June 2016 to June 2022. The chi-square test or Fisher exact test was used to analyze the correlation between clinicopathologic characteristics. Survival curves were plotted using the Kaplan-Meier method, and the Cox regression model was used for univariate and multivariate analysis to search for independent prognostic factors.
Of the 215 eligible patients, 119 patients received adjuvant therapy, and the other 96 patients did not. The median follow-up was 37.5 months. The median OS of CCA patients with and without adjuvant therapy was 45 and 18 months ( < 0.001), respectively. The median PFS of CCA patients with and without adjuvant therapy was 34 and 8 months ( < 0.001), respectively. The Cox univariate and multivariate regression analysis showed that preoperative aspartate transaminase and carbohydrate antigen 19-9, microvascular invasion, lymph node metastasis, differentiation degree, and adjuvant therapy were independent prognostic factors for OS (all values < 0.05). Preoperative carbohydrate antigen 125, microvascular invasion, lymph node metastasis, differentiation degree, and adjuvant therapy were independent prognostic factors for PFS (all values < 0.05). The stratified analysis by TMN stage detected significant differences in the early stages (median OS [mOS]: = 0.0128; median PFS [mPFS]: = 0.0209) and advanced stages (mOS and mPFS: both values < 0.001). Adjuvant therapy was also identified as a significantly favorable prognostic factor for OS and PFS in the early stages and advanced stages.
Postoperative adjuvant therapy can improve the prognosis of patients with CCA, even in the early stages and advanced stages. All data suggest that adjuvant therapy should be incorporated into the treatment of CCA in all cases, where appropriate.
胆管癌（CCA）是一种高度异质性的恶性肿瘤，超过60%的患者术后会复发和转移。CCA术后辅助治疗的疗效仍不明确。本研究旨在探讨辅助治疗是否对CCA患者有益，并研究总生存期（OS）和无进展生存期（PFS）的独立预后因素。
回顾性纳入2016年6月至2022年6月接受手术的CCA患者。采用卡方检验或Fisher确切检验分析临床病理特征之间的相关性。采用Kaplan-Meier法绘制生存曲线，并使用Cox回归模型进行单因素和多因素分析以寻找独立预后因素。
215例符合条件的患者中，119例接受了辅助治疗，另外96例未接受。中位随访时间为37.5个月。接受和未接受辅助治疗的CCA患者的中位OS分别为45个月和18个月（<0.001）。接受和未接受辅助治疗的CCA患者的中位PFS分别为34个月和8个月（<0.001）。Cox单因素和多因素回归分析显示，术前天冬氨酸转氨酶、糖类抗原19-9、微血管侵犯、淋巴结转移、分化程度及辅助治疗是OS的独立预后因素（所有P值<0.05）。术前糖类抗原125、微血管侵犯、淋巴结转移、分化程度及辅助治疗是PFS的独立预后因素（所有P值<0.05）。按TMN分期进行分层分析发现在早期阶段（中位OS[mOS]：P=0.0128；中位PFS[mPFS]：P=0.0209）和晚期阶段（mOS和mPFS：两者P值均<0.001）存在显著差异。辅助治疗在早期和晚期阶段也被确定为OS和PFS的显著有利预后因素。
术后辅助治疗可改善CCA患者的预后，即使在早期和晚期阶段也是如此。所有数据表明，在适当情况下，辅助治疗应纳入所有CCA病例的治疗中。
