| 叶爽,贝宴屏,章慧,等.术后放疗对局部晚期胆道癌患者长期生存的影响——基于SEER数据库的回顾性研究[J].中华放射医学与防护杂志,2021,41(9):665-671.Ye Shuang,Bei Yanping,Zhang Hui,et al.Impacts of postoperative radiotherapy on long-term survival of patients with locally advanced biliary tract cancers——a propensity score-matched analysis based on the SEER database[J].Chin J Radiol Med Prot,2021,41(9):665-671 |
| 术后放疗对局部晚期胆道癌患者长期生存的影响——基于SEER数据库的回顾性研究 |
| Impacts of postoperative radiotherapy on long-term survival of patients with locally advanced biliary tract cancers——a propensity score-matched analysis based on the SEER database |
| 投稿时间：2021-01-12 |
| DOI：10.3760/cma.j.issn.0254-5098.2021.09.005 |
| 中文关键词: 胆道癌 术后放疗 癌症特异性生存率 SEER数据库 |
| 英文关键词:Biliary tract cancers Postoperative radiotherapy Cancer-specific survival(CSS) Epidemiology and End Results(SEER) database |
| 基金项目:浙江省自然科学基金（LY21H160013）；浙江省医药卫生科技项目（2020KY275） |
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| 中文摘要: |
| 目的 探讨术后放疗对可切除局部晚期（T3~4和/或N+）胆道癌患者长期生存的影响以及预后因素分析。方法 利用美国监测、流行病学及预后（Surveillance，Epidemiology and End Results，SEER）数据库收集并筛选出2006—2016年手术切除的局部晚期胆囊癌患者1 922例和肝外胆管癌患者3 408例，根据不同治疗方案分为单纯手术组和手术+放疗组。倾向评分匹配方法用于均衡单纯手术组和手术+放疗组患者的差异性预后特征。使用Kaplan-Meier方法分析两种治疗方案对患者生存的影响，采用Cox回归分析评价预后因素。结果 1 174例胆囊癌患者和2 144例肝外胆管癌患者通过倾向评分进行匹配。与单纯手术组相比，接受术后放疗的胆囊癌患者（χ2=35.73，P< 0.001）和肝外胆管癌患者（χ2=9.878，P=0.002）的5年癌症特异性生存率（cancer-specific survival，CSS）均显著提高。对于胆囊癌及肝外胆管癌患者，病理分级、T分期、N分期、治疗方式和年龄均为影响其预后的独立危险因素，而对于肝外胆管癌患者，种族也是其影响其预后的独立危险因素。除T1-2期胆囊癌患者和病理I~Ⅱ级、N0或70岁以上肝外胆管癌患者以外，其他临床病理特征因素均显示出术后放疗的生存获益。结论 对于可切除局部晚期（T3~4和/或N+）的胆道癌患者，术后放疗与患者长期生存获益相关。但对于T1~2期胆囊癌患者和病理I~Ⅱ级、N0或老年肝外胆管癌患者，应谨慎采用术后放疗的治疗模式。 |
| 英文摘要: |
| Objective To explore the impacts of postoperative radiotherapy on long-term survival of the patients with resectable locally advanced (T3-4and/or N+) biliary tract cancers (BTCs) and to analyze the prognostic factors. Methods The patients with locally advanced gallbladder cancer (n=1 922) and the patients with extrahepatic biliary duct cancer (n=3 408) who received surgical resection during 2006-2016 were selected from the Surveillance, Epidemiology, and End Result (SEER) database. They were grouped according to different treatment schemes (only surgery and surgery + radiation). The propensity score matching (PSM) method was employed to adjust the differences in baseline prognostic characteristics between patients who received only surgery and those treated with surgery+ radiation. The role of the two treatment schemes on the survival of the patients was analyzed using the Kaplan-Meier method and the prognosis factors were assessed using the Cox regression. Results The 1 174 patients with gallbladder cancers and the 2 144 patients with extrahepatic biliary duct cancer were respectively matched according to propensity scores. The postoperative radiotherapy showed a significant advantage in 5-year cancer-specific survival (CSS) compared to only surgery for both the patients with gallbladder cancer (χ2=35.73, P< 0.001) and those with extrahepatic biliary duct cancer (χ2=9.878, P=0.002). After adjusting related covariates, independent prognostic factors for all the patients included pathological grading, T status, N status, treatment pattern, and age. For the patients with extrahepatic biliary duct cancer, independent prognostic factors also included race and year of diagnosis. The benefits of postoperative radiotherapy were observed in various clinicopathologic characteristics except for the patients with T1-2 gallbladder cancer and the extrahepatic biliary duct cancer patients with a pathological grade of Ⅰ-Ⅱ and N0 status or with age ≥ 70. Conclusions Long-term survival benefits can be gained through postoperative radiotherapy for the patients with resectable locally advanced (T3-4 and/or N+) BTCs. However, adjuvant radiation should be cautiously adopted for the patients with T1-2 gallbladder cancer and the extrahepatic biliary duct cancer patients with a pathological grade of I-Ⅱ and N0 status or with age ≥ 70. |
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