Individualizing care for patients with gallbladder cancer

IF 2.3 4区医学 Q3 ONCOLOGY Surgical Oncology-Oxford Pub Date : 2024-11-01 DOI:10.1016/j.suronc.2024.102163

Laura M. Nicolais , Timothy L. Fitzgerald

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Abstract

The rarity and lack of Level I Evidence compromise our ability to care for patients with gallbladder cancer.

Methods

NCDB cohort study of with resected Stage Groups IB-IVA gallbladder adenocarcinoma between 2004 and 2018. Patients were included.

Results

8484 patients were included, median survival was 29.8 (CI 28.6–31.2); Stage IB: 67.0, Stage II: 36.6, and Stage III/IVA 18.4 months. A survival benefit was noted for surgery beyond cholecystectomy (Stage IB 105 vs. 36 months, HR 0.56, p < 0.001; Stage II 56 vs. 20 months, HR 0.72, p < 0.001; and Stage III/IVA 23.8 vs. 9.9 months, HR 0.67, p < 0.001) and chemoradiotherapy (Stage IB 102 vs. 64.8, HR 0.87, CI 0.62–1.23, p = 0.4; ' Stage II 49 vs. 33.5 months, HR 0.78, CI 0.68–0.91, p = 0.002; and Stage III/IVA 31 vs. 12.2 HR 0.60, CI 0.52–0.70, p < 0.001). Adjuvant chemotherapy improved survival in Stage III/IVA (20 vs. 12.2 months, HR 0.74, p < 0.001) but not Stage II and trend toward harm in Stage IB. A nomogram with created with these data.

Conclusion

Surgery beyond cholecystectomy provides a benefit to all. Adjuvant chemotherapy (Stage III and IVA) benefits and chemoradiotherapy (II, III, and IVA) only patients with higher stage disease.

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为胆囊癌患者提供个性化护理

方法对2004年至2018年期间切除的IB-IVA期胆囊腺癌患者进行NCDB队列研究。结果 8484 例患者纳入研究，中位生存期为 29.8 个月（CI 28.6-31.2）；IB 期：67.0 个月；II 期：36.6 个月；III/IVA 期：18.4 个月。除胆囊切除术外，手术治疗也有生存获益（IB期：105个月对36个月，HR 0.56，p <0.001；II期：56个月对20个月，HR 0.72，p <0.001；III/IVA期：23.8个月对9.9个月，HR 0.67，p <0.001）。001）和化放疗（IB 期 102 个月对 64.8 个月，HR 0.87，CI 0.62-1.23，p = 0.4；'II 期 49 个月对 33.5 个月，HR 0.78，CI 0.68-0.91，p = 0.002；III/IVA 期 31 个月对 12.2 个月，HR 0.60，CI 0.52-0.70，p <0.001）。辅助化疗提高了 III/IVA 期患者的生存率（20 个月 vs. 12.2 个月，HR 0.74，p <0.001），但没有提高 II 期患者的生存率，而且 IB 期患者的生存率有下降趋势。根据这些数据绘制了一个提名图。辅助化疗（III 期和 IVA 期）使所有患者受益，化放疗（II 期、III 期和 IVA 期）仅使较高分期的患者受益。

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来源期刊

Surgical Oncology-Oxford 医学-外科

CiteScore

4.50

自引率

0.00%

发文量

169

审稿时长

38 days

期刊介绍： Surgical Oncology is a peer reviewed journal publishing review articles that contribute to the advancement of knowledge in surgical oncology and related fields of interest. Articles represent a spectrum of current technology in oncology research as well as those concerning clinical trials, surgical technique, methods of investigation and patient evaluation. Surgical Oncology publishes comprehensive Reviews that examine individual topics in considerable detail, in addition to editorials and commentaries which focus on selected papers. The journal also publishes special issues which explore topics of interest to surgical oncologists in great detail - outlining recent advancements and providing readers with the most up to date information.