Liu Feng, Qin Yanchao, Li Linjie, Jiao Baoping
Department of Head and Neck Surgery, Shanxi Provincial Cancer Hospital/Shanxi Hospital Cancer Hospital of Chinese Academy of Medical Sciences/Cancer Hospital Affiliated to Shanxi Medical University, Taiyuan, China.
First Clinical Medical School, Shanxi Medical University, Taiyuan, China.
Transl Cancer Res. 2025 Jun 30;14(6):3627-3641. doi: 10.21037/tcr-2024-2543. Epub 2025 Jun 25.
The clinical value of radiotherapy or chemotherapy in gallbladder carcinoma (GBC) remains controversial, especially for GBCs at different stages. Therefore, this study analyzed the effects of radiotherapy, chemotherapy, and concurrent chemoradiotherapy on overall survival (OS) and cancer-specific survival (CSS) in patients with different stages of GBC based on data from the Surveillance, Epidemiology, and End Results (SEER) database.
Data on patients diagnosed with GBC from January 1, 2010 to December 31, 2017 were collected from the SEER database, and those involved patients were divided into the following groups according to their treatment regimens: non-therapy group, radiotherapy alone group, chemotherapy alone group, and concurrent chemoradiotherapy group. After adjusting for factors related to demographics, the tumor, and the procedure, Cox regression was performed to analyze the effect of radiotherapy, chemotherapy, and chemoradiotherapy on OS. The relationships between these three therapies and CSS were assessed using the competing risk model.
This study included 6,275 GBC patients, among whom 3,444 received no therapy, 152 received radiotherapy alone, 1,913 received chemotherapy alone, and 766 received chemoradiotherapy. Of these patients, there were 4,886 (77.86%) all-cause death cases and 4,379 (69.78%) cancer-specific death cases. The multivariate analysis showed that radiotherapy [hazard ratio (HR) =0.700, 95% confidence interval (CI): 0.581, 0.844], chemotherapy (HR =0.500, 95% CI: 0.465, 0.538), and chemoradiotherapy (HR =0.486, 95% CI: 0.439, 0.538) significantly improved OS in all patients (all P<0.001); for stage III and IV GBC patients, radiotherapy, chemotherapy, and chemoradiotherapy significantly improved OS (all P<0.001). Regarding CSS, the competing risk model showed that chemotherapy (HR =0.589, 95% CI: 0.540, 0.635] and chemoradiotherapy (HR =0.577, 95% CI: 0.523, 0.636) improved CSS in all patients (both P<0.001); for patients with stage III GBC, radiotherapy, chemotherapy, and chemoradiotherapy significantly improved CSS (P=0.02, <0.001, <0.001, respectively); and for patients with stage IV GBC, chemotherapy and chemoradiotherapy significantly improved CSS (both P<0.001). The subgroup analyses based on different pathological types showed similar patterns in the effects of radiotherapy, chemotherapy, and chemoradiotherapy on OS and CSS.
Our study shows that advanced gallbladder cancer patients receiving radiotherapy, chemotherapy, or chemoradiotherapy can significantly improve their OS and CSS. Therefore, it is recommended that advanced patients routinely include radiotherapy, chemotherapy, or chemoradiotherapy in comprehensive treatment to improve survival rates. However, for early-stage gallbladder cancer, the improvement effects of radiotherapy, chemotherapy, or chemoradiotherapy on OS and CSS are limited, and the decision to perform radiotherapy or chemotherapy should be individualized based on the patient's specific conditions, such as the pathological type, grade, and lymph node metastasis of the tumor.
放射治疗或化学治疗在胆囊癌（GBC）中的临床价值仍存在争议，尤其是对于不同分期的GBC。因此，本研究基于监测、流行病学和最终结果（SEER）数据库的数据，分析了放射治疗、化学治疗以及同步放化疗对不同分期GBC患者总生存期（OS）和癌症特异性生存期（CSS）的影响。
从SEER数据库收集2010年1月1日至2017年12月31日诊断为GBC的患者数据，并根据治疗方案将这些患者分为以下几组：未治疗组、单纯放疗组、单纯化疗组和同步放化疗组。在对人口统计学、肿瘤和手术相关因素进行校正后，采用Cox回归分析放射治疗、化学治疗和放化疗对OS的影响。使用竞争风险模型评估这三种治疗方法与CSS之间的关系。
本研究纳入6275例GBC患者，其中3444例未接受治疗，152例接受单纯放疗，1913例接受单纯化疗，766例接受同步放化疗。这些患者中，有4886例（77.86%）全因死亡病例和4379例（69.78%）癌症特异性死亡病例。多因素分析显示，放射治疗[风险比（HR）=0.700，95%置信区间（CI）：0.581，0.844]、化学治疗（HR =0.500，95% CI：0.465，0.538）和同步放化疗（HR =0.486，95% CI：0.439，0.538）均显著改善了所有患者的OS（均P<0.001）；对于III期和IV期GBC患者，放射治疗、化学治疗和同步放化疗均显著改善了OS（均P<0.001）。关于CSS，竞争风险模型显示，化学治疗（HR =0.589，95% CI：0.540，0.635）和同步放化疗（HR =0.577，95% CI：0.523，0.636）改善了所有患者的CSS（均P<0.001）；对于III期GBC患者，放射治疗、化学治疗和同步放化疗均显著改善了CSS（分别为P=0.02、<0.001、<0.001）；对于IV期GBC患者，化学治疗和同步放化疗均显著改善了CSS（均P<0.001）。基于不同病理类型的亚组分析显示，放射治疗、化学治疗和同步放化疗对OS和CSS的影响模式相似。
我们的研究表明，接受放射治疗、化学治疗或同步放化疗的晚期胆囊癌患者可显著改善其OS和CSS。因此，建议晚期患者在综合治疗中常规纳入放射治疗、化学治疗或同步放化疗以提高生存率。然而，对于早期胆囊癌，放射治疗、化学治疗或同步放化疗对OS和CSS的改善作用有限，应根据患者的具体情况，如肿瘤的病理类型、分级和淋巴结转移情况，个体化决定是否进行放射治疗或化学治疗。
