肝内胆管癌伴肝外转移的确定性肝脏放疗
Definitive Liver Radiotherapy for Intrahepatic Cholangiocarcinoma with Extrahepatic Metastases.
作者信息
De Brian, Upadhyay Rituraj, Liao Kaiping, Kumala Tiffany, Shi Christopher, Dodoo Grace, Abi Jaoude Joseph, Corrigan Kelsey L, Manzar Gohar S, Marqueen Kathryn E, Bernard Vincent, Lee Sunyoung S, Raghav Kanwal P S, Vauthey Jean-Nicolas, Tzeng Ching-Wei D, Tran Cao Hop S, Lee Grace, Wo Jennifer Y, Hong Theodore S, Crane Christopher H, Minsky Bruce D, Smith Grace L, Holliday Emma B, Taniguchi Cullen M, Koong Albert C, Das Prajnan, Javle Milind, Ludmir Ethan B, Koay Eugene J
机构信息
Department of Gastrointestinal Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
出版信息
Liver Cancer. 2023 Mar 16;12(3):198-208. doi: 10.1159/000530134. eCollection 2023 Aug.
INTRODUCTION
Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the role of L-RT for patients with extrahepatic metastatic disease (M1) remains undefined. We sought to compare outcomes for M1 ICC patients treated with and without L-RT.
METHODS
We reviewed ICC patients that found to have M1 disease at initial diagnosis at a single institution between 2010 and 2021 who received L-RT, matching them with an institutional cohort by propensity score and a National Cancer Database (NCDB) cohort by frequency technique. The median biologically effective dose was 97.5 Gy (interquartile range 80.5-97.9 Gy) for L-RT. Patients treated with other local therapies or supportive care alone were excluded. We analyzed survival with Cox proportional hazard modeling.
RESULTS
We identified 61 patients who received L-RT and 220 who received chemotherapy alone. At median follow-up of 11 months after diagnosis, median OS was 9 months (95% confidence interval [CI] 8-11) and 21 months (CI: 17-26) for patients receiving chemotherapy alone and L-RT, respectively. TRLF was the cause of death more often in the patients who received chemotherapy alone compared to those who received L-RT (82% vs. 47%; = 0.001). On multivariable propensity score-matched analysis, associations with lower risk of death included duration of upfront chemotherapy (hazard ratio [HR] 0.82; = 0.005) and receipt of L-RT (HR: 0.40; = 0.002). The median OS from diagnosis for NCDB chemotherapy alone cohort was shorter than that of the institutional L-RT cohort (9 vs. 22 months; < 0.001).
CONCLUSION
For M1 ICC, L-RT associated with a lower rate of death due to TRLF and longer OS versus those treated with chemotherapy alone. Prospective studies of L-RT in this setting are warranted.
引言
肿瘤相关性肝衰竭（TRLF）是肝内胆管癌（ICC）患者最常见的死亡原因。尽管我们之前表明，局部晚期ICC的肝脏放疗（L-RT）与较低的TRLF发生率和较长的总生存期（OS）相关，但L-RT在肝外转移疾病（M1）患者中的作用仍不明确。我们试图比较接受和未接受L-RT治疗的M1 ICC患者的结局。
方法
我们回顾了2010年至2021年在单一机构初诊时被发现患有M1疾病且接受L-RT的ICC患者，通过倾向评分将他们与机构队列进行匹配，并通过频率技术与国家癌症数据库（NCDB）队列进行匹配。L-RT的中位生物等效剂量为97.5 Gy（四分位间距80.5-97.9 Gy）。排除仅接受其他局部治疗或支持治疗的患者。我们使用Cox比例风险模型分析生存期。
结果
我们确定了61例接受L-RT的患者和220例仅接受化疗的患者。在诊断后中位随访11个月时，仅接受化疗和接受L-RT的患者的中位OS分别为9个月（95%置信区间[CI] 8-11）和21个月（CI：17-26）。与接受L-RT的患者相比，仅接受化疗的患者中TRLF更常是死亡原因（82%对47%；P = 0.001）。在多变量倾向评分匹配分析中，与较低死亡风险相关的因素包括前期化疗持续时间（风险比[HR] 0.82；P = 0.005）和接受L-RT（HR：0.40；P = 0.002）。NCDB仅化疗队列从诊断开始的中位OS短于机构L-RT队列（9对22个月；P < 0.001）。
结论
对于M1 ICC，与仅接受化疗的患者相比，L-RT与因TRLF导致的较低死亡率和较长的OS相关。在这种情况下对L-RT进行前瞻性研究是必要的。
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