辅助放疗可以提高远端胆管癌切除术后的生存率

Data published in Cancer show that patients who receive adjuvant radiation therapy (RT) after resection for distal cholangiocarcinoma (dCCA) experience a survival benefit, even in patients with margin-negative or node-negative resections.

Overview

Because of this survival benefit association, the researchers recommend that adjuvant radiation therapy becomes routine treatment after dCCA resection, regardless of margin and nodal status.

"In this large national registry analysis of 8233 patients, adjuvant RT after dCCA resection was associated with improved survival after multivariable adjustment, creating treatment selection bias," the researchers wrote. "Subset analysis showed that this benefit was maintained regardless of pathologic nodal and margin status."

research findings

Using propensity score matching to account for treatment selection bias, adjuvant therapy was associated with improved survival, median 29.3 months vs 26.8 months (P<.001).

The multivariable-adjusted survival benefit remained (HR, 0.86; 95% CI, 0.80-0.93; P < .001). In addition, multivariable interaction analysis showed that regardless of lymph node status (N0: HR, 0.77; 95% CI, 0.66-0.89; P < .001; N+: HR, 0.79; 95% CI, 0.71-0.89; P < .0 01) or borderline status (R0: HR, 0.58; 95% CI, 0.50-0.67; P < .001; R1: HR, 0.87; 95% CI, 0.78-0.96; P = .007), survival benefits existed.

After propensity score matching was completed, in the initial group (2162 and 4155 respectively), 1509 patients (34%) received adjuvant RT and 1509 patients (66%) did not receive RT. Among them, 39% had negative lymph nodes, 51% had positive lymph nodes, and 10% had unknown lymph node status.

"In this large, nationwide retrospective study, adjuvant RT was associated with a survival benefit in patients with resected dCCA, regardless of pathological lymph node involvement, resection margin status, and adjuvant CT," the researchers wrote. "These data suggest that adjuvant RT should be widely considered in the multimodality treatment of dCCA."

Research methods and limitations

The research team identified patients who underwent pancreaticoduodenectomy for nonmetastatic dCCA through the National Cancer Database from 2004 to 2016. Patients who received neoadjuvant RT and chemotherapy and survived less than 6 months were excluded.

Although the researchers used propensity score matching to eliminate treatment selection bias, they acknowledged that one limitation of the study is that residual bias may still exist. Additionally, specific regimens for the duration and use of adjuvant chemotherapy are not available through the National Cancer Database. This limited the team's analysis of the survival benefit of adjuvant RT-sensitizing chemotherapy.

Summary

"Wide acceptance of the routine use of adjuvant RT in dCCA will also support its use in the neoadjuvant setting, as in pancreatic cancer, where postoperative complications have less impact on the completion of multimodal therapy," the researchers wrote.

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