Landscape of distant metastasis mode and current chemotherapy efficacy of the advanced biliary tract cancer in the United States, 2010-2016
Landscape of distant metastasis mode and current chemotherapy efficacy of the advanced biliary tract cancer in the United States, 2010-2016
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2010-2016年美国晚期胆道癌远处转移模式及化疗效果现状分析
DOI：
10.1002/cam4.2794
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发表时间：
2019-12-26
期刊：
影响因子：
4
通讯作者：
Liu, Houbao
中科院分区：
文献类型：
--
作者：
Wang, Jie;Bo, Xiaobo;Liu, Houbao
背景晚期胆道癌（BTC）的远处转移（DM）模式和治疗效果尚不清楚，迫切需要可靠的评估。方法收集6348例晚期胆管癌患者（ICC，肝内胆管癌，n = 1762; PHCC，肝门周胆管癌，n = 1103; GBC，胆囊癌，n = 2580; DCC，远端胆管癌，n = 538; AVC，乏特壶腹癌，n = 365），均来自SEER数据库。倾向评分匹配（PSM）过程中进行的偏差较小。结果M1型患者在各亚型中的首诊比例分别为ICC 26.4%、PHCC 37.2%、41。GBC、DCC和AVC的DM位点构成存在明显差异。此外，转移部位的生存率不同（P <0.05在所有亚型），其中多转移和远处淋巴结（dLN）仅总是分别表示最差和最好的预后。多变量考克斯模型显示化疗对生存率的影响最显著，风险比最低，在所有亚型中，PSM后仍能改善生存率（P <0.001）。然而，中位月数在有和没有化疗的患者之间表现出不同的亚型（ICC，从5到9; PHCC，从6到10; AVC，从4到9; GBC，从6到7; DCC从6到8）。结论我们提供了一个大规模人群中晚期BTC的详细DM模式的景观，发现了DM部位之间的生存差异，并揭示了BTC亚型之间化疗疗效的差异。
Background The distant metastasis (DM) mode and treatment efficacies in the advanced biliary tract cancer (BTC) were obscure, and a credible evaluation is urgently needed. Method A total of 6348 advanced BTC patients (ICC, intrahepatic cholangiocarcinoma, n = 1762; PHCC, perihilar cholangiocarcinoma, n = 1103; GBC, gallbladder cancer, n = 2580; DCC, distal cholangiocarcinoma, n = 538; AVC, carcinoma of Vater ampulla, n = 365) were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) process was carried out for less bias. Result The proportion of M1 patients in each subtype at first diagnosis was 26.4% (ICC), 37.2% (PHCC), 41. 0% (GBC), 24.5% (DCC), and 12.7% (AVC), and the constitution of DM sites in different subtypes varied apparently. Moreover, the survival of metastasis sites was different (P < .05 in all the subtypes) where the multi-metastasis and distant lymph node (dLN) only always indicated the worst and best prognosis, respectively. Chemotherapy presented the most significant survival impact with the lowest hazard ratio by multivariate cox model and still provided a survival improvement after PSM (all P < .001) in all subtypes. However, the median months manifested different between patients with and without chemotherapy among the subtypes (ICC, from 5 to 9; PHCC, from 6 to 10; AVC, from 4 to 9; GBC, from 6 to 7; DCC from 6 to 8). Conclusion We provided a landscape about the detailed DM mode of the advanced BTC in a large population, found the survival differences among DM sites, and revealed the different chemotherapy efficacies in the BTC subtypes.