Effect of postoperative adjuvant chemotherapy on prognosis of patients with intrahepatic cholangiocarcinoma:a multicenter retrospective study.
10.3760/cma.j.cn112139-20230106-00010
- Author:
Qi Zhu LIN
1
;
Hong Zhi LIU
1
;
Wei Ping ZHOU
2
;
Zhang Jun CHENG
3
;
Jian Ying LOU
4
;
Shu Guo ZHENG
5
;
Xin Yu BI
6
;
Jian Ming WANG
7
;
Wei GUO
8
;
Fu Yu LI
9
;
Jian WANG
10
;
Ya Ming ZHENG
11
;
Jing Dong LI
12
;
Shi CHENG
13
;
Yong Yi ZENG
1
Author Information
1. Department of Hepatobiliary Surgery,Mengchao Hepatobiliary Hospital of Fujian Medical University,Fuzhou 350002,China.
2. Department of Hepatobiliary Surgery Ⅲ, the Third Affiliated Hospital of Naval Medical University,Shanghai 200438,China.
3. Department of Hepatobiliary and Pancreatic Surgery,Zhongda Hospital, Southeast University,Nanjing 210009,China.
4. Department of Hepatobiliary Surgery,the Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China.
5. Department of Hepatobiliary Surgery,the Southwest Hospital of Army Medical University,Chongqing 400038,China.
6. Department of Hepatobiliary Surgery,Cancer Hospital,Peking Union Medical University,Chinese Academy of Medical Sciences,Beijing 100021,China.
7. Department of Hepatobiliary Surgery,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Wuhan 430030,China.
8. Department of Hepatobiliary Surgery,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China.
9. Department of Hepatobiliary Surgery, West China Hospital, Sichuan University,Chengdu 610041,China.
10. Department of Hepatobiliary Surgery,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200127,China.
11. Department of Hepatobiliary Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China.
12. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College,Nanchong 637000,China.
13. Department of Hepatobiliary Surgery,Tiantan Hospital Affiliated to Capital Medical University,Beijing 100070,China.
- Publication Type:Journal Article
- From:
Chinese Journal of Surgery
2023;61(4):305-312
- CountryChina
- Language:Chinese
-
Abstract:
Objectives: To examine the influence of adjuvant chemotherapy after radical resection on the survival of patients with intrahepatic cholangiocarcinoma(ICC) and to identify patients who may benefit from it. Methods: The clinical and pathological data of 654 patients with ICC diagnosed by postoperative pathology from December 2011 to December 2017 at 13 hospitals in China were collected retrospectively. According to the inclusion and exclusion criteria,455 patients were included in this study,including 69 patients (15.2%) who received adjuvant chemotherapy and 386 patients (84.8%) who did not receive adjuvant chemotherapy. There were 278 males and 177 females,with age of 59 (16) years (M(IQR))(range:23 to 88 years). Propensity score matching (PSM) method was used to balance the difference between adjuvant chemotherapy group and non-adjuvant chemotherapy group. Kaplan-Meier method was used to plot the survival curve,the Log-rank test was used to compare the difference of overall survival(OS) and recurrence free survival(RFS)between the two groups. Univariate analysis was used to determine prognostic factors for OS. Multivariate Cox proportional hazards models were then performed for prognostic factors with P<0.10 to identify potential independent risk factors. The study population were stratified by included study variables and the AJCC staging system,and a subgroup analysis was performed using the Kaplan-Meier method to explore the potential benefit subgroup population of adjuvant chemotherapy. Results: After 1∶1 PSM matching,69 patients were obtained in each group. There was no significant difference in baseline data between the two groups (all P>0.05). After PSM,Cox multivariate analysis showed that lymph node metastasis (HR=3.06,95%CI:1.52 to 6.16,P=0.039),width of resection margin (HR=0.56,95%CI:0.32 to 0.99,P=0.044) and adjuvant chemotherapy (HR=0.51,95%CI:0.29 to 0.91,P=0.022) were independent prognostic factors for OS. Kaplan-Meier analysis showed that the median OS time of adjuvant chemotherapy group was significantly longer than that of non-adjuvant chemotherapy group (P<0.05). There was no significant difference in RFS time between the adjuvant chemotherapy group and the non-adjuvant chemotherapy group (P>0.05). Subgroup analysis showed that,the OS of female patients,without HBV infection,carcinoembryonic antigen<9.6 μg/L,CA19-9≥200 U/ml,intraoperative bleeding<400 ml,tumor diameter>5 cm,microvascular invasion negative,without lymph node metastasis,and AJCC stage Ⅲ patients could benefit from adjuvant chemotherapy (all P<0.05). Conclusion: Adjuvant chemotherapy can prolong the OS of patients with ICC after radical resection,and patients with tumor diameter>5 cm,without lymph node metastasis,AJCC stage Ⅲ,and microvascular invasion negative are more likely to benefit from adjuvant chemotherapy.
