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Abstract：
BACKGROUND: Although the role of adjuvant chemotherapy (CT) for resectable biliary tract cancer (BTC) is gradually recognized, the benefit of adjuvant chemoradiotherapy (CRT) is still controversial. Our study is designed to compare the prognosis of CRT versus CT in BCT patients.
METHODS: Clinicopathologic characteristics of patients with operable gallbladder cancer (GBCA), intrahepatic bile duct cancer (IHBDC), or extrahepatic bile duct cancer (EHBDC) were obtained from the Surveillance, Epidemiology and End Results (SEER) database (2004-2015). Univariate and multivariate analyses were performed to identify prognostic factors for overall survival (OS). Selection bias were reduced by propensity-score matching (PSM). Kaplan-Meier analysis was used to estimate the survival time.
RESULTS: Within 922 patients, 53.9% received adjuvant CRT, and 46.1% received adjuvant CT. Multivariate analysis showed age, primary tumor site, T stage, N stage, tumor size, number of removed lymph nodes, and treatment were independent risk factors for OS. Similar improvement of CRT on survival was identified by PSM in the matched cohort compared with CT (28.0 months vs. 25.0 months, p = 0.033), particularly in GBCA cohort (25.0 months vs. 19.0 months, p = 0.003). Subgroup analysis indicated CRT improved outcomes of patients with age ≥ 60, female, lymph nodes positive, tumor size ≥ 5 cm, and none removed lymph node diseases.
CONCLUSIONS: Adjuvant CRT correlated with improved survival in patients with resected BTC compared with adjuvant CT, particularly in GBCAs. In addition, patients with age ≥ 60, female, lymph nodes positive, tumor size ≥ 5 cm, and none removed lymph node diseases may receive more benefits from adjuvant CRT.
METHODS: Clinicopathologic characteristics of patients with operable gallbladder cancer (GBCA), intrahepatic bile duct cancer (IHBDC), or extrahepatic bile duct cancer (EHBDC) were obtained from the Surveillance, Epidemiology and End Results (SEER) database (2004-2015). Univariate and multivariate analyses were performed to identify prognostic factors for overall survival (OS). Selection bias were reduced by propensity-score matching (PSM). Kaplan-Meier analysis was used to estimate the survival time.
RESULTS: Within 922 patients, 53.9% received adjuvant CRT, and 46.1% received adjuvant CT. Multivariate analysis showed age, primary tumor site, T stage, N stage, tumor size, number of removed lymph nodes, and treatment were independent risk factors for OS. Similar improvement of CRT on survival was identified by PSM in the matched cohort compared with CT (28.0 months vs. 25.0 months, p = 0.033), particularly in GBCA cohort (25.0 months vs. 19.0 months, p = 0.003). Subgroup analysis indicated CRT improved outcomes of patients with age ≥ 60, female, lymph nodes positive, tumor size ≥ 5 cm, and none removed lymph node diseases.
CONCLUSIONS: Adjuvant CRT correlated with improved survival in patients with resected BTC compared with adjuvant CT, particularly in GBCAs. In addition, patients with age ≥ 60, female, lymph nodes positive, tumor size ≥ 5 cm, and none removed lymph node diseases may receive more benefits from adjuvant CRT.
摘要：
背景：尽管辅助化疗（CT）对可切除的胆道癌（BTC）的作用已逐渐得到认可，辅助放化疗(CRT)的获益仍存在争议.我们的研究旨在比较BCT患者CRT与CT的预后。
方法：可手术胆囊癌（GBCA）患者的临床病理特征，肝内胆管癌（IHBDC），或肝外胆管癌（EHBDC）从监测中获得，流行病学和最终结果（SEER）数据库（2004-2015年）。进行单变量和多变量分析以确定总生存期（OS）的预后因素。通过倾向评分匹配（PSM）减少了选择偏倚。使用Kaplan-Meier分析来估计生存时间。
结果：在922名患者中，53.9%接受辅助CRT，46.1%接受辅助CT检查。多变量分析显示年龄，原发肿瘤部位，T级,N级,肿瘤大小,切除的淋巴结数量，和治疗是OS的独立危险因素。与CT相比，匹配队列中的PSM发现CRT对生存率的改善相似（28.0个月与25.0个月,p=0.033),特别是在GBCA队列中(25.0个月与19.0个月，p=0.003)。亚组分析显示，年龄≥60岁，女性，淋巴结阳性,肿瘤大小≥5cm,没有切除淋巴结疾病。
结论：与辅助CT相比，辅助CRT与切除BTC患者的生存率改善相关，特别是在GBCA中。此外,年龄≥60岁的患者，女性，淋巴结阳性,肿瘤大小≥5cm,没有切除的淋巴结疾病可能会从辅助CRT中获得更多益处。
方法：可手术胆囊癌（GBCA）患者的临床病理特征，肝内胆管癌（IHBDC），或肝外胆管癌（EHBDC）从监测中获得，流行病学和最终结果（SEER）数据库（2004-2015年）。进行单变量和多变量分析以确定总生存期（OS）的预后因素。通过倾向评分匹配（PSM）减少了选择偏倚。使用Kaplan-Meier分析来估计生存时间。
结果：在922名患者中，53.9%接受辅助CRT，46.1%接受辅助CT检查。多变量分析显示年龄，原发肿瘤部位，T级,N级,肿瘤大小,切除的淋巴结数量，和治疗是OS的独立危险因素。与CT相比，匹配队列中的PSM发现CRT对生存率的改善相似（28.0个月与25.0个月,p=0.033),特别是在GBCA队列中(25.0个月与19.0个月，p=0.003)。亚组分析显示，年龄≥60岁，女性，淋巴结阳性,肿瘤大小≥5cm,没有切除淋巴结疾病。
结论：与辅助CT相比，辅助CRT与切除BTC患者的生存率改善相关，特别是在GBCA中。此外,年龄≥60岁的患者，女性，淋巴结阳性,肿瘤大小≥5cm,没有切除的淋巴结疾病可能会从辅助CRT中获得更多益处。
