{"title":"预测切除胆管癌辅助化疗的 MINT 病理风险评分:泰国倾向评分匹配多中心研究。","authors":"Jitlada Juengsamarn, Chatsuda Sookthon, Kaewta Jeerapradit, Kanin Sriudomporn, Satsawat Chansitthichok, Weeris Ouransatien, Wikran Suragul, Sujitra Boonpob, Poowanai Sarkhampee, Nuttapong Ngamphaiboon","doi":"10.1200/GO-24-00286","DOIUrl":null,"url":null,"abstract":"<p><strong>Purpose: </strong>This study aims to clarify the benefit of adjuvant chemotherapy (AC) in resectable cholangiocarcinoma (CCA) and develop a predictive risk score for treatment selection.</p><p><strong>Methods: </strong>Patients with resected CCA undergoing curative surgery, with or without AC, were identified from three centers in Thailand. Patients with R2 resection and 30 days postoperative death were excluded. Using the largest center as the discovery cohort, we generated propensity score matching (PSM). A predictive model for overall survival (OS) was identified, and a predictive risk score was developed from the PSM discovery cohort, classifying patients into high- and low-risk groups. The proposed risk score was validated in the other two centers.</p><p><strong>Results: </strong>In the discovery cohort, 493 patients were identified. After PSM, 328 patients were categorized into surgery (n = 164) and surgery + AC (n = 164) groups. The baseline characteristics in the PSM discovery cohort were well-balanced. In the validation cohort (n = 83), patients with positive lymph node 1 received AC more frequently than those under observation (47% <i>v</i> 18%; <i>P</i> = .02). A MINT pathologic risk score was developed from multivariate analysis for OS. The score includes margin, perineural invasion, pathologic nodal status, and pathologic tumor size. In the PSM discovery cohort, for the low-risk score group, the surgery group had significantly longer OS compared with the surgery + AC group (49.4 <i>v</i> 31.5 months; hazard ratio [HR], 1.78 [95% CI, 1.11 to 2.86]; <i>P</i> = .016). Conversely, for the high-risk score group, the surgery + AC group had better OS than the surgery group (18.8 <i>v</i> 8 months; HR, 0.60 [95% CI, 0.46 to 0.79]; <i>P</i> < .001). The results were comparable in the validation cohort.</p><p><strong>Conclusion: </strong>Patients with resected CCA with a high-risk MINT pathologic risk score were likely to benefit from AC, whereas those with a low-risk score were not. Further validation in a larger prospective cohort is warranted.</p>","PeriodicalId":14806,"journal":{"name":"JCO Global Oncology","volume":null,"pages":null},"PeriodicalIF":3.2000,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Predictive MINT Pathologic Risk Score for Adjuvant Chemotherapy in Resected Cholangiocarcinoma: A Propensity Score-Matched Multicenter Study in Thailand.\",\"authors\":\"Jitlada Juengsamarn, Chatsuda Sookthon, Kaewta Jeerapradit, Kanin Sriudomporn, Satsawat Chansitthichok, Weeris Ouransatien, Wikran Suragul, Sujitra Boonpob, Poowanai Sarkhampee, Nuttapong Ngamphaiboon\",\"doi\":\"10.1200/GO-24-00286\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Purpose: </strong>This study aims to clarify the benefit of adjuvant chemotherapy (AC) in resectable cholangiocarcinoma (CCA) and develop a predictive risk score for treatment selection.</p><p><strong>Methods: </strong>Patients with resected CCA undergoing curative surgery, with or without AC, were identified from three centers in Thailand. Patients with R2 resection and 30 days postoperative death were excluded. Using the largest center as the discovery cohort, we generated propensity score matching (PSM). A predictive model for overall survival (OS) was identified, and a predictive risk score was developed from the PSM discovery cohort, classifying patients into high- and low-risk groups. The proposed risk score was validated in the other two centers.</p><p><strong>Results: </strong>In the discovery cohort, 493 patients were identified. After PSM, 328 patients were categorized into surgery (n = 164) and surgery + AC (n = 164) groups. The baseline characteristics in the PSM discovery cohort were well-balanced. In the validation cohort (n = 83), patients with positive lymph node 1 received AC more frequently than those under observation (47% <i>v</i> 18%; <i>P</i> = .02). A MINT pathologic risk score was developed from multivariate analysis for OS. The score includes margin, perineural invasion, pathologic nodal status, and pathologic tumor size. In the PSM discovery cohort, for the low-risk score group, the surgery group had significantly longer OS compared with the surgery + AC group (49.4 <i>v</i> 31.5 months; hazard ratio [HR], 1.78 [95% CI, 1.11 to 2.86]; <i>P</i> = .016). Conversely, for the high-risk score group, the surgery + AC group had better OS than the surgery group (18.8 <i>v</i> 8 months; HR, 0.60 [95% CI, 0.46 to 0.79]; <i>P</i> < .001). The results were comparable in the validation cohort.</p><p><strong>Conclusion: </strong>Patients with resected CCA with a high-risk MINT pathologic risk score were likely to benefit from AC, whereas those with a low-risk score were not. Further validation in a larger prospective cohort is warranted.</p>\",\"PeriodicalId\":14806,\"journal\":{\"name\":\"JCO Global Oncology\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2024-10-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"JCO Global Oncology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1200/GO-24-00286\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/10/17 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"ONCOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"JCO Global Oncology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1200/GO-24-00286","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/17 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}
引用次数: 0
摘要
目的:本研究旨在明确辅助化疗(AC)对可切除胆管癌(CCA)的益处,并为治疗选择制定预测性风险评分:方法:从泰国的三个中心确定了接受根治性手术的切除胆管癌(CCA)患者,无论是否接受辅助化疗。排除R2切除和术后30天死亡的患者。以最大的中心作为发现队列,我们进行了倾向评分匹配(PSM)。我们确定了总生存期(OS)的预测模型,并根据 PSM 发现队列制定了预测风险评分,将患者分为高风险组和低风险组。所提出的风险评分在另外两个中心进行了验证:结果:在发现队列中确定了 493 名患者。PSM 后,328 名患者被分为手术组(164 人)和手术 + AC 组(164 人)。PSM发现队列的基线特征非常均衡。在验证队列(n = 83)中,淋巴结 1 呈阳性的患者接受 AC 的比例高于接受观察的患者(47% v 18%; P = .02)。通过对 OS 进行多变量分析,得出了 MINT 病理风险评分。该评分包括边缘、神经周围侵犯、病理结节状态和病理肿瘤大小。在PSM发现队列中,就低风险评分组而言,手术组的OS明显长于手术+ AC组(49.4个月v 31.5个月;危险比[HR],1.78 [95% CI,1.11至2.86];P = .016)。相反,对于高风险评分组,手术 + AC 组的 OS 好于手术组(18.8 个月对 8 个月;HR,0.60 [95% CI,0.46 对 0.79];P <.001)。验证队列的结果与之相当:结论:切除的CCA患者中,MINT病理风险评分为高风险的患者有可能从AC中获益,而评分为低风险的患者则不能从AC中获益。有必要在更大的前瞻性队列中进行进一步验证。
Predictive MINT Pathologic Risk Score for Adjuvant Chemotherapy in Resected Cholangiocarcinoma: A Propensity Score-Matched Multicenter Study in Thailand.
Purpose: This study aims to clarify the benefit of adjuvant chemotherapy (AC) in resectable cholangiocarcinoma (CCA) and develop a predictive risk score for treatment selection.
Methods: Patients with resected CCA undergoing curative surgery, with or without AC, were identified from three centers in Thailand. Patients with R2 resection and 30 days postoperative death were excluded. Using the largest center as the discovery cohort, we generated propensity score matching (PSM). A predictive model for overall survival (OS) was identified, and a predictive risk score was developed from the PSM discovery cohort, classifying patients into high- and low-risk groups. The proposed risk score was validated in the other two centers.
Results: In the discovery cohort, 493 patients were identified. After PSM, 328 patients were categorized into surgery (n = 164) and surgery + AC (n = 164) groups. The baseline characteristics in the PSM discovery cohort were well-balanced. In the validation cohort (n = 83), patients with positive lymph node 1 received AC more frequently than those under observation (47% v 18%; P = .02). A MINT pathologic risk score was developed from multivariate analysis for OS. The score includes margin, perineural invasion, pathologic nodal status, and pathologic tumor size. In the PSM discovery cohort, for the low-risk score group, the surgery group had significantly longer OS compared with the surgery + AC group (49.4 v 31.5 months; hazard ratio [HR], 1.78 [95% CI, 1.11 to 2.86]; P = .016). Conversely, for the high-risk score group, the surgery + AC group had better OS than the surgery group (18.8 v 8 months; HR, 0.60 [95% CI, 0.46 to 0.79]; P < .001). The results were comparable in the validation cohort.
Conclusion: Patients with resected CCA with a high-risk MINT pathologic risk score were likely to benefit from AC, whereas those with a low-risk score were not. Further validation in a larger prospective cohort is warranted.