Abstract：
OBJECTIVE: Outcomes of unresectable biliary tract cancer (BTC) with varying extents of liver involvement remain unclear. We evaluated characteristics and outcomes of BTC patients with liver metastases who underwent chemotherapy.
METHODS: We retrospectively reviewed consecutive BTC patients with synchronous or metachronous intrahepatic metastases who started first-line chemotherapy at our institution between January 2016 and December 2021.
RESULTS: Ninety-six patients were included, of which 57 only had liver metastases and 39 had multiorgan involvement. The liver only group had longer median overall survival (OS) (11.8 vs. 7.4 months, P = 0.006) and median progression-free survival (PFS) (4.1 vs. 2.7 months, P = 0.035) than the multiorgan group. Patients with oligometastases (defined as no more than three liver metastases) achieved longer OS than those with polymetastases (four or more liver metastases) in the entire cohort. Within the liver only group, there were no significant differences in OS or PFS between the oligometastasis and polymetastasis groups. Patients who underwent subsequent surgery had significantly longer median OS than those who did not (44.4 vs. 7.7 months, P < 0.001). Age ≥ 75 years, liver-only metastasis, modified Glasgow prognostic score ≥ 1 carcinoembryonic antigen ≥ 5 μg/L, and subsequent surgery were independent predictors of OS. Liver oligometastasis was only a significant predictor of longer OS in univariate Cox analysis.
CONCLUSIONS: Outcomes in BTC patients with metastases limited to the liver, particularly those with oligometastasis, were more favorable than those with multiorgan metastases. Selected cases, generally with liver oligometastases, may achieve prolonged OS through subsequent surgery.
METHODS: We retrospectively reviewed consecutive BTC patients with synchronous or metachronous intrahepatic metastases who started first-line chemotherapy at our institution between January 2016 and December 2021.
RESULTS: Ninety-six patients were included, of which 57 only had liver metastases and 39 had multiorgan involvement. The liver only group had longer median overall survival (OS) (11.8 vs. 7.4 months, P = 0.006) and median progression-free survival (PFS) (4.1 vs. 2.7 months, P = 0.035) than the multiorgan group. Patients with oligometastases (defined as no more than three liver metastases) achieved longer OS than those with polymetastases (four or more liver metastases) in the entire cohort. Within the liver only group, there were no significant differences in OS or PFS between the oligometastasis and polymetastasis groups. Patients who underwent subsequent surgery had significantly longer median OS than those who did not (44.4 vs. 7.7 months, P < 0.001). Age ≥ 75 years, liver-only metastasis, modified Glasgow prognostic score ≥ 1 carcinoembryonic antigen ≥ 5 μg/L, and subsequent surgery were independent predictors of OS. Liver oligometastasis was only a significant predictor of longer OS in univariate Cox analysis.
CONCLUSIONS: Outcomes in BTC patients with metastases limited to the liver, particularly those with oligometastasis, were more favorable than those with multiorgan metastases. Selected cases, generally with liver oligometastases, may achieve prolonged OS through subsequent surgery.
摘要：
目的：不同程度肝脏受累的不可切除的胆道癌（BTC）的预后尚不清楚。我们评估了接受化疗的BTC肝转移患者的特征和预后。
方法：我们回顾性回顾了2016年1月至2021年12月在我们机构开始一线化疗的连续BTC同步或异时性肝内转移患者。
结果：纳入96例患者，其中57例仅有肝转移，39例有多器官受累。仅肝脏组的中位总生存期（OS）更长（11.8vs.7.4个月，P=0.006）和中位无进展生存期（PFS）（4.1vs.2.7个月,P=0.035）比多器官组。在整个队列中，具有寡转移酶（定义为不超过三个肝转移）的患者比具有多转移（四个或更多个肝转移）的患者获得更长的OS。在只有肝脏的组中，寡转移和多转移组之间的OS或PFS没有显着差异。接受后续手术的患者的中位OS明显长于未接受手术的患者（44.4vs.7.7个月，P<0.001)。年龄≥75岁，仅肝转移，改良格拉斯哥预后评分≥1个癌胚抗原≥5μg/L，和随后的手术是OS的独立预测因子。在单变量Cox分析中，肝寡转移仅是延长OS的重要预测指标。
结论：BTC患者的结果转移局限于肝脏，尤其是那些具有寡转移的人，比多器官转移者更有利。精选案例，通常与肝脏寡转移，可能通过后续手术实现延长OS。
方法：我们回顾性回顾了2016年1月至2021年12月在我们机构开始一线化疗的连续BTC同步或异时性肝内转移患者。
结果：纳入96例患者，其中57例仅有肝转移，39例有多器官受累。仅肝脏组的中位总生存期（OS）更长（11.8vs.7.4个月，P=0.006）和中位无进展生存期（PFS）（4.1vs.2.7个月,P=0.035）比多器官组。在整个队列中，具有寡转移酶（定义为不超过三个肝转移）的患者比具有多转移（四个或更多个肝转移）的患者获得更长的OS。在只有肝脏的组中，寡转移和多转移组之间的OS或PFS没有显着差异。接受后续手术的患者的中位OS明显长于未接受手术的患者（44.4vs.7.7个月，P<0.001)。年龄≥75岁，仅肝转移，改良格拉斯哥预后评分≥1个癌胚抗原≥5μg/L，和随后的手术是OS的独立预测因子。在单变量Cox分析中，肝寡转移仅是延长OS的重要预测指标。
结论：BTC患者的结果转移局限于肝脏，尤其是那些具有寡转移的人，比多器官转移者更有利。精选案例，通常与肝脏寡转移，可能通过后续手术实现延长OS。
