The role of surgery and adjuvant therapy in lymph node-positive cancers of the gallbladder and intrahepatic bile ducts
The role of surgery and adjuvant therapy in lymph node-positive cancers of the gallbladder and intrahepatic bile ducts
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DOI：
10.1002/cncr.30968
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发表时间：
2018-01-01
期刊：
影响因子：
6.2
通讯作者：
Massarweh, Nader N.
中科院分区：
文献类型：
--
作者：
Cao, Hop S. Tran;Zhang, Qianzi;Massarweh, Nader N.
背景：淋巴结转移是胆道癌（BTC）预后不良的因素。BTC伴局部淋巴结阳性患者的最佳治疗方法，包括手术和辅助治疗（AT）的影响尚不清楚。方法：这是一项在国家癌症数据库（2004-2012）中T1-T3 N1 M0胆囊癌（GBC）和肝内胆管癌（IHC）患者中进行的回顾性队列研究。按治疗方法（非手术、手术、手术+AT）对患者进行分类。采用多变量考克斯回归分析评价死亡总风险与治疗策略之间的关系。结果：GBC患者（n = 1335）的手术切除率为84.1%，IHC患者（n = 1009）的手术切除率为36.6%。非手术组、手术组和手术加AT组GBC患者的中位总生存期分别为11.6、13.3和19.6个月（对数秩P < .001），IHC患者的中位总生存期分别为12.7、16.2和22.6个月（对数秩P < .001）。与非手术治疗相比，有或没有AT的手术与GBC死亡风险较低相关（AT手术：风险比[HR]，0.59; 95%置信区间[CI]，0.48-0.73;无AT手术：HR，0.71; 95% CI，0.56-0.89）和来自IHC（AT手术：HR，0.52; 95% CI，0.42-0.63;无AT手术：HR，0.70; 95% CI，0.56-0.87）。对于GBC患者，无论切缘状态如何，包括放疗在内的AT与单独手术相比死亡风险较低相关（切缘阴性切除：HR，0.66; 95%CI，0.52-0.84;切缘阳性切除：HR，0.54; 95%CI，0.39-0.75），但单独辅助化疗与此无关。对于免疫组化患者，无论是边缘阳性或边缘阴性切除，辅助化疗或放疗均未检测到生存益处。结论：淋巴结阳性BTC患者的最佳结局与切缘阴性切除相关，对于GBC患者，无论切缘状态如何，均应纳入辅助化疗和放疗。癌症2018;124：74-83。(c)2017美国癌症协会
BACKGROUND: Lymph node metastasis is a poor prognostic factor for biliary tract cancers (BTCs). The optimal management of patients who have BTC with positive regional lymph nodes, including the impact of surgery and adjuvant therapy (AT), is unclear. METHODS: This was a retrospective cohort study of patients who had T1-T3N1M0 gallbladder cancer (GBC) and intrahepatic cholangiocarcinoma (IHC) in the National Cancer Database (2004-2012). Patients were classified by treatment approach (nonoperative, surgery, surgery plus AT). Associations between the overall risk of death and treatment strategy were evaluated with multivariable Cox regression. RESULTS: Rates of surgical resection were 84.1% for patients with GBC (n = 1335) and 36.6% for those with IHC (n = 1009). The median overall survival of patients in the nonoperative, surgery, and surgery plus AT group was 11.6, 13.3, and 19.6 months, respectively, for those with GBC (log-rank P < .001), and 12.7, 16.2, and 22.6 months, respectively, for those with IHC (log-rank P < .001), respectively. Compared with nonoperative therapy, surgery with or without AT was associated with a lower risk of death from GBC (surgery with AT: hazard ratio [HR], 0.59; 95% confidence interval [CI], 0.48-0.73; surgery without AT: HR, 0.71; 95% CI, 0.56-0.89) and from IHC (surgery with AT: HR, 0.52; 95% CI, 0.42-0.63; surgery without AT: HR, 0.70; 95% CI, 0.56-0.87). AT that included radiation was associated with a lower risk of death relative to surgery alone for patients with GBC regardless of margin status (margin-negative resection: HR, 0.66; 95% CI, 0.52-0.84; margin-positive resection: HR, 0.54; 95% CI, 0.39-0.75), but adjuvant chemotherapy alone was not. For patients with IHC, no survival benefit was detected with adjuvant chemotherapy or radiation for those who underwent either margin-positive or margin-negative resection. CONCLUSIONS: The best outcomes for patients who have lymph node-positive BTCs are associated with margin-negative resection and, in those who have GBC, the inclusion of adjuvant chemotherapy with radiation regardless of margin status. Cancer 2018;124:74-83. (c) 2017 American Cancer Society.