肝内胆管癌肝外转移的明确肝放射治疗。

IF 11.6 1区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Liver Cancer Pub Date : 2023-03-16 eCollection Date: 2023-08-01 DOI:10.1159/000530134
Brian De, Rituraj Upadhyay, Kaiping Liao, Tiffany Kumala, Christopher Shi, Grace Dodoo, Joseph Abi Jaoude, Kelsey L Corrigan, Gohar S Manzar, Kathryn E Marqueen, Vincent Bernard, Sunyoung S Lee, Kanwal P S Raghav, Jean-Nicolas Vauthey, Ching-Wei D Tzeng, Hop S Tran Cao, Grace Lee, Jennifer Y Wo, Theodore S Hong, Christopher H Crane, Bruce D Minsky, Grace L Smith, Emma B Holliday, Cullen M Taniguchi, Albert C Koong, Prajnan Das, Milind Javle, Ethan B Ludmir, Eugene J Koay
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引用次数: 0

摘要

引言:肿瘤相关肝功能衰竭(TRLF)是肝内胆管癌(ICC)患者最常见的死亡原因。尽管我们之前表明,局部晚期ICC的肝脏放射治疗(L-RT)与TRLF频率较低和总生存期(OS)较长有关,但L-RT在肝外转移性疾病(M1)患者中的作用仍不明确。我们试图比较接受L-RT和不接受L-RT治疗的M1 ICC患者的结果。方法:我们回顾了2010年至2021年间在一家机构接受L-RT的初步诊断时发现患有M1疾病的ICC患者,通过倾向评分将其与一个机构队列和一个国家癌症数据库(NCDB)队列进行匹配。L-RT的中位生物有效剂量为97.5Gy(四分位间距80.5-97.9Gy)。仅接受其他局部治疗或支持性护理的患者被排除在外。我们用Cox比例风险模型分析生存率。结果:我们确定了61名接受L-RT的患者和220名单独接受化疗的患者。在诊断后11个月的中位随访中,单独接受化疗和L-RT的患者的中位OS分别为9个月(95%置信区间[CI]8-11)和21个月(CI:17-26)。与接受L-RT的患者相比,单独接受化疗的患者中TRLF是更常见的死亡原因(82%对47%;p=0.001)。在多变量倾向评分匹配分析中,与较低死亡风险相关的因素包括前期化疗的持续时间(危险比[HR]0.82;p=0.005)和接受L-RT(HR:0.40;p=0.002)。仅NCDB化疗队列的中位OS诊断时间短于机构L-RT队列(9个月对22个月;p<0.001)。结论:对于M1 ICC,与单独化疗相比,L-RT与TRLF和较长OS导致的死亡率较低有关。在这种情况下对L-RT进行前瞻性研究是有必要的。
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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Definitive Liver Radiotherapy for Intrahepatic Cholangiocarcinoma with Extrahepatic Metastases.

Introduction: Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the role of L-RT for patients with extrahepatic metastatic disease (M1) remains undefined. We sought to compare outcomes for M1 ICC patients treated with and without L-RT.

Methods: We reviewed ICC patients that found to have M1 disease at initial diagnosis at a single institution between 2010 and 2021 who received L-RT, matching them with an institutional cohort by propensity score and a National Cancer Database (NCDB) cohort by frequency technique. The median biologically effective dose was 97.5 Gy (interquartile range 80.5-97.9 Gy) for L-RT. Patients treated with other local therapies or supportive care alone were excluded. We analyzed survival with Cox proportional hazard modeling.

Results: We identified 61 patients who received L-RT and 220 who received chemotherapy alone. At median follow-up of 11 months after diagnosis, median OS was 9 months (95% confidence interval [CI] 8-11) and 21 months (CI: 17-26) for patients receiving chemotherapy alone and L-RT, respectively. TRLF was the cause of death more often in the patients who received chemotherapy alone compared to those who received L-RT (82% vs. 47%; p = 0.001). On multivariable propensity score-matched analysis, associations with lower risk of death included duration of upfront chemotherapy (hazard ratio [HR] 0.82; p = 0.005) and receipt of L-RT (HR: 0.40; p = 0.002). The median OS from diagnosis for NCDB chemotherapy alone cohort was shorter than that of the institutional L-RT cohort (9 vs. 22 months; p < 0.001).

Conclusion: For M1 ICC, L-RT associated with a lower rate of death due to TRLF and longer OS versus those treated with chemotherapy alone. Prospective studies of L-RT in this setting are warranted.

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来源期刊
Liver Cancer
Liver Cancer Medicine-Oncology
CiteScore
20.80
自引率
7.20%
发文量
53
审稿时长
16 weeks
期刊介绍: Liver Cancer is a journal that serves the international community of researchers and clinicians by providing a platform for research results related to the causes, mechanisms, and therapy of liver cancer. It focuses on molecular carcinogenesis, prevention, surveillance, diagnosis, and treatment, including molecular targeted therapy. The journal publishes clinical and translational research in the field of liver cancer in both humans and experimental models. It publishes original and review articles and has an Impact Factor of 13.8. The journal is indexed and abstracted in various platforms including PubMed, PubMed Central, Web of Science, Science Citation Index, Science Citation Index Expanded, Google Scholar, DOAJ, Chemical Abstracts Service, Scopus, Embase, Pathway Studio, and WorldCat.
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