胆囊腺癌患者术后辅助化疗的生存获益：一项更新的回顾性队列分析。

Survival benefit of adjuvant chemotherapy in patients with resected gallbladder adenocarcinoma: An updated retrospective cohort analysis.

机构信息

Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310009, China; Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, 310009, China; Research Center of Diagnosis and Treatment Technology for Hepatocellular Carcinoma of Zhejiang Province, 310009, China; Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, 310009, China; Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, 310009, China; Cancer Center, Zhejiang University, Hangzhou, 310009, China.

出版信息

Eur J Surg Oncol. 2024 Apr;50(4):108047. doi: 10.1016/j.ejso.2024.108047. Epub 2024 Feb 21.

DOI:10.1016/j.ejso.2024.108047

PMID:38401352

Abstract

BACKGROUND

The rarity yet high malignancy of gallbladder adenocarcinoma (GBA) endows it with a distinctive nature. Radical resection remains the foremost therapeutic approach for GBA, while the impact of early recurrence and metastasis on patient prognosis necessitates the utilization of adjuvant chemotherapy (AC). Despite numerous previous studies on this topic, a consensus regarding the authentic efficacy of AC has yet to be reached.

METHODS

We conducted an updated retrospective cohort analysis utilizing data from the Surveillance, Epidemiology, and End Results (SEER) database spanning from 2010 to 2020 to explore the association between AC and survival outcomes in patients with resected GBA.

RESULTS

Our study included 2782 patients from the SEER database, with further evaluation of 843 patients in each cohort following meticulous execution of a 1:1 propensity score matching. Remarkably, the AC cohort exhibited a significant survival advantage when juxtaposed against the non-AC cohort. Multivariable Cox regression analysis identified age at diagnosis, year at diagnosis, grade, AJCC T stage, AJCC N stage as well as AC as independent prognostic factors. Furthermore, our findings unveiled that poor/undifferentiated tumor histology, pathological T2 or higher category and pathological N1 category were significantly associated with improved survival when treated with AC while simultaneously observing improved survival across all age categories.

CONCLUSION

These results provide additional evidence supporting the survival benefits of AC and offer guidance for personalized therapy in patients with resected GBA.

摘要

背景

胆囊腺癌（GBA）的罕见性和高度恶性使其具有独特的性质。根治性切除术仍然是 GBA 的首要治疗方法，而早期复发和转移对患者预后的影响需要辅助化疗（AC）。尽管之前有许多关于这个主题的研究，但对于 AC 的真实疗效尚未达成共识。

方法

我们利用 2010 年至 2020 年期间来自监测、流行病学和最终结果（SEER）数据库的数据进行了更新的回顾性队列分析，以探讨 AC 与接受 GBA 切除术的患者生存结果之间的关系。

结果

我们的研究纳入了 SEER 数据库中的 2782 名患者，在仔细执行 1:1 倾向评分匹配后，对每个队列中的 843 名患者进行了进一步评估。值得注意的是，AC 组与非 AC 组相比具有显著的生存优势。多变量 Cox 回归分析确定年龄、诊断年份、分级、AJCC T 分期、AJCC N 分期以及 AC 是独立的预后因素。此外，我们的研究结果表明，接受 AC 治疗时，肿瘤组织学差/未分化、病理 T2 或更高分期以及病理 N1 分期与生存改善显著相关，同时观察到所有年龄组的生存均有所改善。