Abstract：
The National Comprehensive Cancer Network (NCCN) guidelines recommend adjuvant therapy for patients with resectable cholangiocarcinoma (CCA). The trends in utilization and receipt of adjuvant therapy and its association with overall survival have not been well studied among patients with low-risk CCA.
Patients who received systemic chemotherapy for low-risk CCA after surgical resection (2010-2017) were identified in the National Cancer Database. Low-risk CCA was defined according to NCCN guidelines as patients with R0 margins and negative regional lymph nodes. Multivariable analysis was performed to assess predictors of NCCN guideline concordance and its association with overall survival.
Among 4519 patients who underwent resection for low-risk CCA, 55.5% (n = 2510) had intrahepatic, 15.0% (n = 680) had perihilar, and 29.4% (n = 1329) had distal cholangiocarcinoma. Adherence to NCCN guidelines increased from 27.7% in 2010 to 41.6% in 2017 (ptrend < 0.001) for low-risk CCA. On multivariable analysis, receipt of NCCN guideline-concordant care was associated with a nearly 15% decrease in mortality hazards (HR 0.86, 95%CI 0.78-0.95, [Formula: see text]). Increased distance travelled (Ref < 12.5 miles, 50-249 miles: OR 0.55, 95%CI 0.49-0.69; ≥ 250 miles: OR 0.41, 95%CI 0.25-0.6), and care in the South (OR 0.78, 95%CI 0.64-0.95) or Midwest (OR 0.66, 95%CI 0.53-0.81) of the United States versus the Northeast was associated with not receiving guideline-concordant care.
Adherence to evidence-based NCCN guidelines was associated with improved survival among low-risk CCA patients. Geographical disparities in the receipt of NCCN guideline-concordant care exist and may influence long-term outcomes among CCA patients.
Patients who received systemic chemotherapy for low-risk CCA after surgical resection (2010-2017) were identified in the National Cancer Database. Low-risk CCA was defined according to NCCN guidelines as patients with R0 margins and negative regional lymph nodes. Multivariable analysis was performed to assess predictors of NCCN guideline concordance and its association with overall survival.
Among 4519 patients who underwent resection for low-risk CCA, 55.5% (n = 2510) had intrahepatic, 15.0% (n = 680) had perihilar, and 29.4% (n = 1329) had distal cholangiocarcinoma. Adherence to NCCN guidelines increased from 27.7% in 2010 to 41.6% in 2017 (ptrend < 0.001) for low-risk CCA. On multivariable analysis, receipt of NCCN guideline-concordant care was associated with a nearly 15% decrease in mortality hazards (HR 0.86, 95%CI 0.78-0.95, [Formula: see text]). Increased distance travelled (Ref < 12.5 miles, 50-249 miles: OR 0.55, 95%CI 0.49-0.69; ≥ 250 miles: OR 0.41, 95%CI 0.25-0.6), and care in the South (OR 0.78, 95%CI 0.64-0.95) or Midwest (OR 0.66, 95%CI 0.53-0.81) of the United States versus the Northeast was associated with not receiving guideline-concordant care.
Adherence to evidence-based NCCN guidelines was associated with improved survival among low-risk CCA patients. Geographical disparities in the receipt of NCCN guideline-concordant care exist and may influence long-term outcomes among CCA patients.
摘要：
背景：国家综合癌症网络（NCCN）指南建议对可切除的胆管癌（CCA）患者进行辅助治疗。在低风险CCA患者中，辅助治疗的使用和接受趋势及其与总生存率的关系尚未得到很好的研究。
方法：在国家癌症数据库中确定了在手术切除后（2010-2017年）接受低危CCA全身化疗的患者。根据NCCN指南将低风险CCA定义为具有R0边缘和区域淋巴结阴性的患者。进行多变量分析以评估NCCN指南一致性的预测因子及其与总生存期的相关性。
结果：在4519例接受低风险CCA切除的患者中，55.5％（n=2510）肝内，15.0%(n=680)有肺门周围，29.4％（n=1329）患有远端胆管癌。对于低风险CCA，NCCN指南的依从性从2010年的27.7%增加到2017年的41.6%(ptrend<0.001)。在多变量分析中，接受NCCN指南一致治疗与死亡率风险降低近15%相关(HR0.86,95CI0.78-0.95,[公式:见正文]).行驶距离增加(编号<12.5英里,50-249英里：OR0.55，95CI0.49-0.69；≥250英里：OR0.41，95CI0.25-0.6），美国南部(OR0.78,95CI0.64-0.95)或中西部(OR0.66,95CI0.53-0.81)的护理与美国东北部未接受指南一致的护理相关.
结论：坚持基于证据的NCCN指南与低危CCA患者的生存率改善相关。在接受NCCN指南一致护理方面存在地理差异，并且可能会影响CCA患者的长期结局。
方法：在国家癌症数据库中确定了在手术切除后（2010-2017年）接受低危CCA全身化疗的患者。根据NCCN指南将低风险CCA定义为具有R0边缘和区域淋巴结阴性的患者。进行多变量分析以评估NCCN指南一致性的预测因子及其与总生存期的相关性。
结果：在4519例接受低风险CCA切除的患者中，55.5％（n=2510）肝内，15.0%(n=680)有肺门周围，29.4％（n=1329）患有远端胆管癌。对于低风险CCA，NCCN指南的依从性从2010年的27.7%增加到2017年的41.6%(ptrend<0.001)。在多变量分析中，接受NCCN指南一致治疗与死亡率风险降低近15%相关(HR0.86,95CI0.78-0.95,[公式:见正文]).行驶距离增加(编号<12.5英里,50-249英里：OR0.55，95CI0.49-0.69；≥250英里：OR0.41，95CI0.25-0.6），美国南部(OR0.78,95CI0.64-0.95)或中西部(OR0.66,95CI0.53-0.81)的护理与美国东北部未接受指南一致的护理相关.
结论：坚持基于证据的NCCN指南与低危CCA患者的生存率改善相关。在接受NCCN指南一致护理方面存在地理差异，并且可能会影响CCA患者的长期结局。
