Impact of adjuvant chemotherapy on prognosis in intrahepatic cholangiocarcinoma patients underwent radical resection.
10.3760/cma.j.cn112139-20220110-00021
- Author:
Jing Bo SU
1
;
Jing Wei ZHANG
2
;
Chen CHEN
1
;
Ying He QIU
3
;
Hong WU
4
;
Tian Qiang SONG
5
;
Yu HE
6
;
Xian Hai MAO
7
;
Wen Long ZHAI
8
;
Zhang Jun CHENG
9
;
Jing Dong LI
10
;
Shu Bin SI
2
;
Zhi Qiang CAI
2
;
Zhi Min GENG
1
;
Zhao Hui TANG
11
Author Information
1. Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China.
2. Department of Industrial Engineering,School of Mechanical Engineering,Northwestern Polytechnical University,Xi'an 710072,China.
3. Department of Biliary Surgery,Eastern Hepatobiliary Hospital Affiliated to Naval Medical University,Shanghai 200433,China.
4. Department of Liver Surgery,Liver Transplantation Center,West China Hospital of Sichuan University,Chengdu 610041,China.
5. Department of Hepatobiliary Oncology,Tianjin Medical University Cancer Hospital,Tianjin 300060,China.
6. Department of Hepatobiliary Surgery,the First Hospital Affiliated to Army Medical University,Chongqing 400038,China.
7. Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,Changsha 410005,China.
8. Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China.
9. Department of Hepatobiliary Surgery,Zhongda Hospital of Southeast University,Nanjing 210009,China.
10. Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China.
11. Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University,School of Medicine,Shanghai 200092,China.
- Publication Type:Journal Article
- MeSH:
Bayes Theorem;
Bile Duct Neoplasms/surgery*;
Bile Ducts, Intrahepatic/pathology*;
Chemotherapy, Adjuvant;
Cholangiocarcinoma/surgery*;
Female;
Humans;
Male;
Prognosis;
Retrospective Studies
- From:
Chinese Journal of Surgery
2022;60(4):356-362
- CountryChina
- Language:Chinese
-
Abstract:
Objectives: To investigate the clinical value of adjuvant chemotherapy(ACT) in patients with intrahepatic cholangiocarcinoma(ICC) who underwent radical resection and to explore the optimal population that can benefit from ACT. Methods: A retrospective cohort study method was adopted. The clinical and pathological data of 685 patients with ICC who underwent curative intent resection in 10 Chinese hepatobiliary surgery centers from January 2010 to December 2018 were collected;There were 355 males and 330 females. The age(M(IQR)) was 58(14) years (range: 22 to 83 years). Propensity score matching(PSM) was applied to balance the differences between the adjuvant and non-adjuvant chemotherapy groups. Log-rank test was used to compare the prognosis of the two groups of patients. A Bayesian network recurrence-free survival(RFS) prediction model was constructed using the median RFS time (14 months) as the target variable, and the importance of the relevant prognostic factors was ranked according to the multistate Birnbaum importance calculation. A survival prognostic prediction table was established to analyze the population benefiting from adjuvant chemotherapy. Results: Among 685 patients,214 received ACT and 471 did not receive ACT. A total of 124 pairs of patients were included after PSM, and patients in the ACT group had better overall survival (OS) and RFS than those in the non-ACT group(OS: 32.2 months vs. 18.0 months,P=0.003;RFS:18.0 months vs. 10.0 months,P=0.001). The area under the curve of the Bayesian network RFS prediction model was 0.7124. The results of the prognostic factors in order of importance were microvascular invasion (0.158 2),perineural invasion (0.158 2),N stage (0.155 8),T stage (0.120 9), hepatic envelope invasion (0.090 3),adjuvant chemotherapy (0.072 1), tumor location (0.057 5), age (0.042 3), pathological differentiation (0.034 0), sex (0.029 3), alpha-fetoprotein (0.028 9) and preoperative jaundice (0.008 5). A survival prediction table based on the variables with importance greater than 0.1 (microvascular invasion,perineural invasion,N stage,T staging) and ACT showed that all patients benefited from ACT (increase in the probability of RFS≥14 months from 2.21% to 7.68%), with a more significant increase in the probability of RFS≥14 months after ACT in early-stage patients. Conclusion: ACT after radical resection in patients with ICC significantly prolongs the OS and RFS of patients, and the benefit of ACT is greater in early patients.
