Dong Jun, Zhu Zhengqiu
Xuzhou Medical University, Xuzhou, Jiangsu, China.
Department of Medical Oncology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
Front Oncol. 2024 Nov 25;14:1511583. doi: 10.3389/fonc.2024.1511583. eCollection 2024.
To investigate the effectiveness of neoadjuvant therapy and lymph node dissection(LND) on overall survival (OS) in patients with stage III/IV gallbladder cancer without distant metastases.
Data from 101 patients who received neoadjuvant therapy followed by surgery combined with adjuvant chemotherapy, and 1412 patients who received direct surgical treatment followed by adjuvant chemotherapy, were collected from the SEER database from 2004 to 2020. Patients were divided into group A (neoadjuvant therapy) and group B (direct surgery) based on the treatment modality. A total of 202 cases were obtained after propensity score matching, with 101 cases in each group (A and B). Cox unifactorial and multifactorial analyses were performed to identify independent risk factors for patients with advanced cholecystic carcinoma, and the Kaplan-Meier method was used to analyze overall survival (OS). The Cox proportional hazards model was used to investigate the effect of different subgroups on OS in both patient groups. Further survival analyses were conducted to determine whether lymph node dissection(LND) was beneficial for patients receiving neoadjuvant therapy for gallbladder cancer.
Cox univariate analysis showed that marital status, AJCC stage, number of LND, tumor size, and treatment modality were associated with OS (P<0.05). Cox multifactorial regression analysis indicated that AJCC stage, LND, tumor size, and treatment modality were independent risk factors for OS in patients with non-metastatic advanced gallbladder cancer (P<0.05). Survival curves demonstrated that the OS in group A was longer than in group B (median OS: 30 months vs. 14 months, P<0.001). Subgroup analysis indicated that neoadjuvant therapy had a consistent effect on the OS of patients with advanced gallbladder cancer, improving both survival time and outcomes. Survival curves indicated that lymph node dissection was not significant in group A patients (p>0.05) but was significant in group B (p<0.05).
Neoadjuvant therapy can improve the OS of patients with non-metastatic stage III/IV gallbladder cancer and is an independent risk factor affecting prognosis; however, the significance of lymph node dissection in these patients still needs further study.
探讨新辅助治疗及淋巴结清扫术（LND）对无远处转移的Ⅲ/Ⅳ期胆囊癌患者总生存期（OS）的影响。
从2004年至2020年的监测、流行病学与最终结果（SEER）数据库中收集101例接受新辅助治疗后行手术联合辅助化疗的患者以及1412例接受直接手术治疗后行辅助化疗的患者的数据。根据治疗方式将患者分为A组（新辅助治疗）和B组（直接手术）。经倾向评分匹配后共获得202例患者，每组各101例（A组和B组）。进行Cox单因素和多因素分析以确定晚期胆囊癌患者的独立危险因素，并采用Kaplan-Meier法分析总生存期（OS）。使用Cox比例风险模型研究不同亚组对两组患者OS的影响。进行进一步的生存分析以确定淋巴结清扫术（LND）对接受胆囊癌新辅助治疗的患者是否有益。
Cox单因素分析显示，婚姻状况、美国癌症联合委员会（AJCC）分期、淋巴结清扫数量、肿瘤大小和治疗方式与总生存期相关（P<0.05）。Cox多因素回归分析表明，AJCC分期、淋巴结清扫术、肿瘤大小和治疗方式是非转移性晚期胆囊癌患者总生存期的独立危险因素（P<0.05）。生存曲线显示，A组的总生存期长于B组（中位总生存期：30个月对14个月，P<0.001）。亚组分析表明，新辅助治疗对晚期胆囊癌患者的总生存期有一致的影响，可改善生存时间和结局。生存曲线表明，淋巴结清扫术对A组患者无显著影响（p>0.05），但对B组有显著影响（p<0.05）。
新辅助治疗可改善无远处转移的Ⅲ/Ⅳ期胆囊癌患者的总生存期，是影响预后的独立危险因素；然而，这些患者中淋巴结清扫术的意义仍需进一步研究。
