Survival benefit of conversion surgery for initially unresectable biliary tract cancer: a systematic review and meta-analysis.

IF 1.8 3区医学 Q2 SURGERY Langenbeck's Archives of Surgery Pub Date : 2025-02-07 DOI:10.1007/s00423-025-03630-x

Yanming Zhou, Qingxiang Wang, Mingjing Lin, Shijie Wang

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Abstract

Purpose: Combination of gemcitabine and cisplatin (GemCis) is the current first-line treatment for unresectable biliary tract cancer (UR-BTC), but it confers a median overall survival (OS) of less than one year. This study aimed to evaluate the survival benefit of conversion surgery for initially UR-BTC.

Methods: Eligible studies published between January 2000 and May 2024 were identified via an electronic search of PubMed and Web of Science databases. The primary endpoint was OS.

Results: Included in this study were 96 observational studies involving 466 patients with 231 cases (49.6%) of intrahepatic cholangiocarcinoma, 131 cases of (28.1%) extrahepatic cholangiocarcinoma, and 104 cases (22.3%) of gallbladder cancer. The 90-day mortality rate was 4.3%, and the median survival duration was 36.8 (17.9-57.6) months, with a 1-, 3- and 5-year OS rate of 86% (74-95.9%), 59.9% (32.3-78.7%), and 41.1% (24-58.5%) respectively. Meta-analysis showed that survival in patients who underwent conversion surgery was significantly higher than that in those who received non-surgical treatment (hazard ratio [HR] 0.39, P < 0.001) and comparable to that in those who underwent up-front surgery for resectable cancer (HR 1.02, P = 0.43). Pooled analysis of 149 individual participant data showed that male gender (HR 20.649, P = 0.014) and lymph node metastasis (HR 14.671, P = 0.005) were independently associated with reduced OS.

Conclusion: Conversion surgery is justified in initially UR-BTC with favorable long-term survival, and may prove to be a promising option for the multimodality treatment of UR-BTC.

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初始不可切除胆道癌转换手术的生存获益：系统回顾和荟萃分析。

目的：吉西他滨联合顺铂（GemCis）是目前治疗不可切除胆道癌（eur - btc）的一线治疗方案，但它的中位总生存期（OS）不到一年。本研究旨在评估早期UR-BTC转换手术的生存效益。方法：通过PubMed和Web of Science数据库的电子检索确定2000年1月至2024年5月间发表的符合条件的研究。主要终点为OS。结果：本研究纳入96项观察性研究，共纳入466例患者，其中肝内胆管癌231例（49.6%），肝外胆管癌131例（28.1%），胆囊癌104例（22.3%）。90天死亡率为4.3%，中位生存时间为36.8（17.9-57.6）个月，1、3、5年OS分别为86%（74-95.9%）、59.9%（32.3-78.7%）、41.1%（24-58.5%）。meta分析显示，接受转换手术的患者的生存率明显高于接受非手术治疗的患者（风险比[HR] 0.39， P）。结论：转换手术在早期UR-BTC中是合理的，具有良好的长期生存，可能被证明是UR-BTC多模式治疗的一个有希望的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Langenbeck's Archives of Surgery 医学-外科

CiteScore

3.30

自引率

8.70%

发文量

342

审稿时长

4-8 weeks

期刊介绍： Langenbeck''s Archives of Surgery aims to publish the best results in the field of clinical surgery and basic surgical research. The main focus is on providing the highest level of clinical research and clinically relevant basic research. The journal, published exclusively in English, will provide an international discussion forum for the controlled results of clinical surgery. The majority of published contributions will be original articles reporting on clinical data from general and visceral surgery, while endocrine surgery will also be covered. Papers on basic surgical principles from the fields of traumatology, vascular and thoracic surgery are also welcome. Evidence-based medicine is an important criterion for the acceptance of papers.