The impact of S-1 for the patient with lymph nodal metastasis biliary tract cancer as adjuvant chemotherapy: a multicenter database analysis
The impact of S-1 for the patient with lymph nodal metastasis biliary tract cancer as adjuvant chemotherapy: a multicenter database analysis
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DOI：
10.1007/s10147-022-02165-1
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发表时间：
2022-04-15
影响因子：
3.3
通讯作者：
Ikegami, Toru
中科院分区：
文献类型：
--
作者：
Hamura, Ryoga;Haruki, Koichiro;Ikegami, Toru
虽然辅助化疗有望改善胆道癌患者根治性切除术后的预后，但关于辅助化疗的疗效和预后因素的证据有限。我们调查了胆道癌患者使用S-1辅助化疗的有效亚组。方法收集2009年至2019年在我院四所附属医院行胆道癌根治性切除术的413例患者。通过单变量和多变量分析研究了辅助化疗与总体和患者亚组长期结局的相关性。结果在所有患者中，S-1辅助化疗并没有改善无病生存率（p = 0.29）和总生存率（p = 0.83）。在亚组分析中，S-1辅助化疗改善了淋巴结转移、晚期（III和IV期）和显微镜下残留肿瘤患者的无病生存期和总生存期。在135例有淋巴结转移的患者中，67例（50%）患者接受了S-1辅助化疗。对于有淋巴结转移的患者，术前胆管引流（p = 0.01）和辅助化疗（p = 0.04）是无病生存的独立和重要的预测因素，而术前胆管引流（p = 0.03）、肿瘤分化程度（p = 0.03）和辅助化疗（p = 0.03）是总生存期的独立和重要预测因素。结论胆道癌术后有淋巴结转移的患者，应用替吉奥辅助化疗可获得较好的疗效。
Introduction Although adjuvant chemotherapy is expected to improve the prognosis for patients with biliary tract cancer after curative resection, there is limited evidence regarding the efficacy and prognostic factors of adjuvant chemotherapy. We investigated the effective subgroups for whom adjuvant chemotherapy with S-1 in biliary tract cancer patients. Methods 413 patients who underwent curative resection for biliary tract cancer at our four affiliated hospitals between 2009 and 2019 were included in this study. The association of adjuvant chemotherapy with long-term outcomes in overall and patient subgroups were investigated by univariate and multivariate analyses. Results Among overall patients, adjuvant chemotherapy with S-1 did not improve disease free survival (p = 0.29) and overall survival (p = 0.83). In the subgroup analysis, adjuvant chemotherapy with S-1 improved both disease-free and overall survival in patients with lymph node metastasis, advanced Stage (III and IV), and microscopic residual tumor. In 135 patients with lymph node metastasis, adjuvant chemotherapy with S-1 was given in 67 patients (50%). In the patients with lymph node metastasis, preoperative bile duct drainage (p = 0.01) and adjuvant chemotherapy (p = 0.04) were independent and significant predictors of disease-free survival, while preoperative bile duct drainage (p = 0.03), tumor differentiation (p = 0.03), and adjuvant chemotherapy (p = 0.03) were independent and significant predictors of overall survival. Conclusion After resection of biliary tract cancer, adjuvant chemotherapy with S-1 appears to benefit those who had lymph node metastasis.