Neither neoadjuvant nor adjuvant therapy increases survival after biliary tract cancer resection with wide negative margins.
Neither neoadjuvant nor adjuvant therapy increases survival after biliary tract cancer resection with wide negative margins.
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DOI：
10.1007/s11605-012-1935-1
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发表时间：
2012-09
影响因子：
3.2
通讯作者：
Curley, Steven A.
中科院分区：
文献类型：
--
作者：
Glazer, Evan S.;Liu, Ping;Abdalla, Eddie K.;Vauthey, Jean-Nicolas;Curley, Steven A.
我们研究了新辅助/辅助治疗对可切除胆道癌生存率的作用。我们假设新辅助和辅助治疗可以提高这些患者的生存概率。这是一项对因胆囊癌（GBC）和胆管癌（CC）而切除的患者的前瞻性数据库进行的回顾性审查。157例患者因原发性GBC（n=63）和CC（n=94）接受了切除术。Fisher精确检验、Student t检验、对数秩检验和考克斯比例风险模型确定了显著差异。胆囊癌和胆囊癌切除后5年总生存率分别为50.6%和30.4%。在这些患者中，17.8%接受了新辅助化疗，48.7%接受了辅助化疗，而15.8%接受了辅助放化疗。切缘阴性者5年生存率为52.4%（P<0.01）.辅助治疗没有显著延长生存期。新辅助治疗平均延迟手术切除6.8个月（p<0.0001）。立即切除使中位生存期从42.3个月增加到53.5个月（p=0.01）。胆道恶性肿瘤的早期手术切除，无肿瘤边缘1厘米提供了长期生存的最佳可能性。目前可用的新辅助或辅助治疗不能改善生存率。
We investigated the role of neoadjuvant/adjuvant therapies on survival for resectable biliary tract cancer. We hypothesized that neoadjuvant and adjuvant therapy should improve the survival probability in these patients. This was a retrospective review of a prospective database of patients resected for gallbladder cancer (GBC) and cholangiocarcinoma (CC). One hundred fifty-seven patients underwent resection for primary GBC (n=63) and CC (n=94). Fisher’s exact test, Student’s t test, the log-rank test, and a Cox proportional hazard model determined significant differences. The 5-year overall survival rate after resection of GBC and CC was 50.6 % and 30.4 %, respectively. Of the patients, 17.8 % received neoadjuvant chemotherapy, 48.7 % received adjuvant chemotherapy, while 15.8 % received adjuvant chemoradiotherapy. Patients with negative margins of at least 1 cm had a 5-year survival rate of 52.4 % (p<0.01). Adjuvant therapy did not significantly prolong survival. Neoadjuvant therapy delayed surgical resection on average for 6.8 months (p<0.0001). Immediate resection increased median survival from 42.3 to 53.5 months (p=0.01). Early surgical resection of biliary tract malignancies with 1 cm tumor-free margins provides the best probability for long-term survival. Currently available neoadjuvant or adjuvant therapy does not improve survival.
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