Natural history of metastatic biliary tract cancer (BTC) patients with good performance status (PS) who were treated with only best supportive care (BSC)
Natural history of metastatic biliary tract cancer (BTC) patients with good performance status (PS) who were treated with only best supportive care (BSC)
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DOI：
10.1093/jjco/hyu210
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发表时间：
2015-03-01
影响因子：
2.4
通讯作者：
Kang, Jung-Hun
中科院分区：
文献类型：
--
作者：
Ji, Jun Ho;Song, Haa-Na;Kang, Jung-Hun
背景资料：虽然化疗被广泛推荐用于转移性胆道癌患者，这些患者的自然病程，特别是那些具有良好的性能状态谁是化疗，是未知的。方法：我们回顾性分析了转移性或局部晚期胆道癌患者被诊断为6个癌症中心。如果患者表现良好（ECOG 0-2）并且没有任何癌症治疗史，则符合资格。主要目的是评估晚期胆管癌患者的生存时间，表现良好，未经治疗。结果：在1677例患者中，204例符合纳入标准。中位年龄和总生存期为72.0年和7.1个月。按部位分类的总生存期（月）为：肝内癌4.7个月，肝外癌9.7个月，胆囊癌4.4个月，壶腹癌11.2个月。在亚组分析中，局部晚期胆管癌的总生存期为13.8个月，癌胚抗原/碳水化合物抗原19-9正常的患者为10.6个月。在多变量分析中，与不良预后相关的变量是转移性胆管癌[风险比2.19（P = 0.001）]，高基线癌胚抗原水平（定义为> 4.0 ng/ml）[风险比1.51（P = 0.024）]和高基线碳水化合物抗原19-9水平（定义为> 100 U/ml）[风险比1.93结论：晚期胆道癌患者在没有任何治疗的情况下，表现出中等的生存率。此外，亚组分析显示，糖链抗原19-9或癌胚抗原水平正常或局部晚期状态的患者具有良好的生存率。对不能切除的胆道癌患者进行化疗与最佳支持治疗的结果进行比较的进一步研究是必要的。
Background: Although chemotherapy is widely recommended for patients with metastatic biliary tract cancer, the natural course of these patients, especially those with good performance status who are indicated for chemotherapy, is not known.Methods: We retrospectively reviewed patients with metastatic or locally advanced biliary cancer who were diagnosed at six cancer centers. Patients were eligible if they had good performance (ECOG 0-2) and no history of any treatment for cancer. The primary objective was to evaluate the survival time of patients with advanced biliary cancer with good performance who were untreated.Results: Of the 1677 patients, 204 met the inclusion criteria. The median age and overall survival were 72.0 years and 7.1 months. Overall survival (months) by location was 4.7 for intrahepatic, 9.7 for extrahepatic, 4.4 for gallbladder and 11.2 for ampulla of vater cancer. In subgroup analysis, overall survival of locally advanced biliary cancer was 13.8 months and that of patients with normal carcinoembryonic antigen/carbohydrate antigen 19-9 was 10.6 months. In multivariate analysis, variables that were associated with poor prognosis were metastatic biliary cancer [hazard ratio 2.19 (P = 0.001)], high baseline carcinoembryonic antigen level (defined as > 4.0 ng/ml) [hazard ratio 1.51 (P = 0.024)] and high baseline carbohydrate antigen 19-9 level (defined as > 100 U/ml) [hazard ratio 1.93 (P = 0.001)].Conclusions: Advanced biliary tract cancer with good performance status showed modest survival without any treatment. Furthermore, subgroup analysis showed that patients with normal carbohydrate antigen 19-9 or carcinoembryonic antigen level or locally advanced status had favorable survival. Further studies comparing the outcome of chemotherapy with that of best supportive care in patients with unresectable biliary tract cancer are warranted.