Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Department of Oncology, University Hospitals Seidman Cancer Center and Case Western Reserve University, Cleveland, OH, USA.
Eur J Surg Oncol. 2023 Nov;49(11):106994. doi: 10.1016/j.ejso.2023.106994. Epub 2023 Jul 27.
Most patients with localized cholangiocarcinoma (CCA) endure cancer relapse after curative resection underscoring the importance of systemic therapy. The current study attempts to determine the impact of perioperative chemotherapy (PC) on survival in patients with CCA undergoing resection.
Patients diagnosed with CCA undergoing curative-intent resection between January 1, 2000, and December 31, 2019, in a tertiary care center were included. Cox proportional hazard modeling was used to determine the impact of PC on disease-free survival (DFS) and overall survival (OS). In addition, a nomogram was constructed to estimate 3-year DFS.
Among the 182 patients included in the analysis, 102 underwent surgery alone, and 80 received surgery plus PC. Forty-two patients received neoadjuvant therapy, and 38 patients received adjuvant therapy. On multivariate analysis, PC was significantly associated with an improved DFS (HR, 95% CI: 0.63, 0.41-0.98; p = 0.04) and OS (HR, 95% CI: 0.46, 0.27-0.78; p < 0.01). In the interaction analysis, the survival benefit was especially seen in patients with positive resection margins and tumor size > 5 cm.
In patients with CCA undergoing curative resection, receipt of PC was associated with improved DFS and OS. The nomogram constructed from this database provides an estimate of 3-year DFS after surgical resection. Randomized trials are needed to define the optimal regimen and sequence.
大多数局限性胆管癌（CCA）患者在根治性切除术后会经历癌症复发，这突显了全身治疗的重要性。本研究试图确定围手术期化疗（PC）对接受切除术的 CCA 患者生存的影响。
纳入 2000 年 1 月 1 日至 2019 年 12 月 31 日在一家三级护理中心接受根治性切除术的 CCA 患者。使用 Cox 比例风险模型确定 PC 对无病生存率（DFS）和总生存率（OS）的影响。此外，构建了一个列线图来估计 3 年 DFS。
在纳入分析的 182 名患者中，102 名仅接受手术，80 名接受手术加 PC。42 名患者接受新辅助治疗，38 名患者接受辅助治疗。多变量分析显示，PC 与改善的 DFS（HR，95%CI：0.63，0.41-0.98；p=0.04）和 OS（HR，95%CI：0.46，0.27-0.78；p<0.01）显著相关。在交互分析中，在切缘阳性和肿瘤大小>5cm 的患者中，生存获益尤其明显。
在接受根治性切除术的 CCA 患者中，接受 PC 与改善的 DFS 和 OS 相关。从这个数据库构建的列线图提供了手术后 3 年 DFS 的估计。需要进行随机试验来确定最佳方案和顺序。
