Role of adjuvant(chemo)radiotherapy for resected extrahepatic cholangiocarcinoma:a meta-analysis  

辅助放(化)疗在肝外胆管细胞癌中的作用:荟萃分析

作　　者：Xin-qi SHI Jing-yu ZHANG Hua TIAN Ling-na TANG Ai-lin LI 

机构地区：[1]Department of Radiation Oncology,the First Hospital of China Medical University,Shenyang 110001,China

出　　处：《Journal of Zhejiang University-Science B(Biomedicine & Biotechnology)》2020年第7期549-559,共11页浙江大学学报（英文版）B辑（生物医学与生物技术）

基　　金：Project supported by the National Natural Science Foundation of China(No.81402520)。

摘　　要：Background:Adjuvant(chemo)radiotherapy(A(C)RT)may be an important supplement to surgery for extrahepatic cholangiocarcinoma(EHCC).However,whether all patients would achieve benefits from A(C)RT and which adjuvant regimen,adjuvant radiotherapy(ART)or adjuvant chemoradiotherapy(ACRT),would be preferred,are still undetermined.The low incidence of EHCC makes it difficult to carry out randomized controlled trials(RCTs);therefore,almost all clinical studies on radiotherapy are retrospective.We have conducted a meta-analysis of these retrospective studies.Methods:We conducted a meta-analysis of current retrospective studies using PubMed,Embase,and ClinicalTrials databases.All studies published in English that were related to A(C)RT and which analyzed overall survival(OS),disease-free survival(DFS),or locoregional recurrence-free survival(LRFS)were included.Estimated hazard ratios(HRs)were calculated for OS,DFS,and LRFS.Results:Data from eight studies including 685 patients were included.Our analysis showed that A(C)RT significantly improved OS(HR 0.69,95%confidence interval(CI)0.48–0.97,P=0.03),DFS(HR 0.60,95%CI 0.47–0.76,P<0.0001),and LRFS(HR 0.27,95%CI 0.17–0.41,P<0.00001)of EHCC overall.In subgroups,patients with microscopically positive resection margin(R1)could achieve a benefit from A(C)RT(HR 0.44,95%CI 0.27–0.72,P=0.001).No statistically OS difference was observed in negative resection margin(R0)subgroup(HR 0.98,95%CI 0.30–3.19,P=0.98).Significant OS benefit was found in patients who received concurrent ACRT(HR 0.40,95%CI 0.26–0.62,P<0.0001),while the result of ART without chemotherapy showed no significant benefit(HR 1.14,95%CI 0.29–4.50,P=0.85).In the distal cholangiocarcinoma subgroup,no significant difference was seen when ACRT and ART were included(HR 0.61,95%CI 0.14–2.72,P=0.52),but a significant difference was seen ewOshSpe,enDc iaFanlSla,yl yianzn iddn igsL ttRahlF ep Sca iotinne cEnutHrsr.C eCnt pAaCtieRnTt so,nelys p(eHcRi a0 ll.y2 i9 n,t9 h5 o%s eC Iw i0 t.h13 R–10 r.e6 s4 e,cPti=o0 n目的:分析术后辅助放(化)疗在肝外胆管细胞癌中的作用,找到具体哪些临床亚组能从辅助放(化)疗中获益。创新点:本研究报告了辅助放(化)疗可以改善肝外胆管细胞癌患者尤其是显微镜下切缘阳性患者的总生存期、无病生存期和无转移生存期,为这一无定论的临床问题提供循证证据。方法:我们检索了截至2019年10月,收录在Pub Med、Embase和Clinical Trials三个数据库中关于术后辅助放(化)疗在肝外胆管细胞癌中的作用的文献。经过筛选,最终有8篇文献符合纳入标准,并采用Rev Man软件进行数据分析。结论:辅助放(化)疗可以改善肝外胆管细胞癌患者的总生存期、无病生存期和无转移生存期,尤其是在显微镜下阳性切缘的患者中。辅助同步放化疗可能优于单纯辅助放疗,尤其是在远端胆管癌患者中。

关 键 词：Adjuvant(chemo)radiotherapy Extrahepatic cholangiocarcinoma META-ANALYSIS Disease-free survival Overall survival 

分 类 号：R735.8[医药卫生—肿瘤] R730.5[医药卫生—临床医学]