PDF(Pubmed)
Abstract：
BACKGROUND: Biliary tract cancers (BTC) are rare and aggressive malignancies originating from intrahepatic and extrahepatic bile ducts and the gallbladder. Surgery is the only curative option, but due to late-stage diagnosis, is frequently not feasible, leaving chemotherapy as the primary treatment. Radiotherapy (RT) can be an effective alternative for patients with unresectable, non-metastatic BTC despite the generally poor prognosis and significant variability. To help manage patients with unresectable BTC who receive RT, we aimed to identify prognostic markers that could aid in predicting overall survival (OS).
METHODS: A retrospective cohort study was conducted at the University of Pennsylvania, involving seventy-eight patients with unresectable BTC treated with definitive intent RT. Comprehensive demographic, clinical, and treatment-related data were extracted from the electronic medical records. Univariate and multivariate Cox regressions were employed to identify predictors of OS after RT. A biomarker model was developed for refined survival prediction.
RESULTS: The cohort primarily comprised patients with good performance status without significant hepatic dysfunction at presentation. The predominant treatment approach involved hypofractionated RT or concurrent 5FU-based chemoRT. Median OS after RT was 12.3 months, and 20 patients (15.6%) experienced local progression with a median time of 30.1 months. Univariate and multivariate analyses identified CA19-9 (above median) and higher albumin-bilirubin (ALBI) grades at presentation as significant predictors of poor OS. Median OS after RT was 24 months for patients with no risk factors and 6.3 months for those with both.
CONCLUSIONS: Our study demonstrates generally poor but significantly heterogeneous OS in patients with unresectable BTC treated with RT. We have developed a biomarker model based on CA19-9 and ALBI grade at presentation that can distinguish sub-populations with markedly diverse prognoses. This model can aid the clinical management of this challenging disease.
METHODS: A retrospective cohort study was conducted at the University of Pennsylvania, involving seventy-eight patients with unresectable BTC treated with definitive intent RT. Comprehensive demographic, clinical, and treatment-related data were extracted from the electronic medical records. Univariate and multivariate Cox regressions were employed to identify predictors of OS after RT. A biomarker model was developed for refined survival prediction.
RESULTS: The cohort primarily comprised patients with good performance status without significant hepatic dysfunction at presentation. The predominant treatment approach involved hypofractionated RT or concurrent 5FU-based chemoRT. Median OS after RT was 12.3 months, and 20 patients (15.6%) experienced local progression with a median time of 30.1 months. Univariate and multivariate analyses identified CA19-9 (above median) and higher albumin-bilirubin (ALBI) grades at presentation as significant predictors of poor OS. Median OS after RT was 24 months for patients with no risk factors and 6.3 months for those with both.
CONCLUSIONS: Our study demonstrates generally poor but significantly heterogeneous OS in patients with unresectable BTC treated with RT. We have developed a biomarker model based on CA19-9 and ALBI grade at presentation that can distinguish sub-populations with markedly diverse prognoses. This model can aid the clinical management of this challenging disease.
摘要：
背景：胆道癌（BTC）是起源于肝内和肝外胆管和胆囊的罕见且侵袭性的恶性肿瘤。手术是唯一的治疗选择,但由于晚期诊断,往往是不可行的，将化疗作为主要治疗方法。放射治疗（RT）可以是一种有效的替代治疗不可切除的患者，非转移性BTC，尽管预后普遍较差且差异显著。为了帮助管理接受RT的不可切除BTC患者，我们旨在鉴定有助于预测总生存期(OS)的预后标志物.
方法：在宾夕法尼亚大学进行了一项回顾性队列研究，涉及78例接受明确意图RT治疗的不可切除BTC患者。综合人口统计，临床,并从电子病历中提取治疗相关数据.单变量和多变量Cox回归用于确定RT后OS的预测因子。开发了生物标志物模型用于精细的生存预测。
结果：该队列主要包括表现良好的患者，在出现时没有明显的肝功能障碍。主要的治疗方法涉及低分割RT或同时基于5FU的化疗RT。RT后的中位OS为12.3个月，20例患者(15.6%)出现局部进展,中位时间为30.1个月.单变量和多变量分析确定CA19-9（高于中位数）和较高的白蛋白-胆红素（ALBI）等级是OS差的重要预测因子。无危险因素的患者在RT后的中位OS为24个月，两者均为6.3个月。
结论：我们的研究表明，在接受RT治疗的不可切除的BTC患者中，OS普遍较差，但显著异质性。我们已经开发了一种基于CA19-9和ALBI等级的生物标志物模型，该模型可以区分具有明显不同预后的亚群。该模型可以帮助这种具有挑战性的疾病的临床管理。
方法：在宾夕法尼亚大学进行了一项回顾性队列研究，涉及78例接受明确意图RT治疗的不可切除BTC患者。综合人口统计，临床,并从电子病历中提取治疗相关数据.单变量和多变量Cox回归用于确定RT后OS的预测因子。开发了生物标志物模型用于精细的生存预测。
结果：该队列主要包括表现良好的患者，在出现时没有明显的肝功能障碍。主要的治疗方法涉及低分割RT或同时基于5FU的化疗RT。RT后的中位OS为12.3个月，20例患者(15.6%)出现局部进展,中位时间为30.1个月.单变量和多变量分析确定CA19-9（高于中位数）和较高的白蛋白-胆红素（ALBI）等级是OS差的重要预测因子。无危险因素的患者在RT后的中位OS为24个月，两者均为6.3个月。
结论：我们的研究表明，在接受RT治疗的不可切除的BTC患者中，OS普遍较差，但显著异质性。我们已经开发了一种基于CA19-9和ALBI等级的生物标志物模型，该模型可以区分具有明显不同预后的亚群。该模型可以帮助这种具有挑战性的疾病的临床管理。
