Hui Liang1, Yifan Wang1, Jie Chen2, Jiajun Xing3, Yabin Pu1. 1. Department of General Surgery, Naval Medical Center of PLA, Shanghai, China. 2. Department of Cardiothoracic Surgery, Naval Medical Center of PLA, Shanghai, China. 3. Department of Orthopedics, Naval Medical Center of PLA, Shanghai, China.
Abstract
BACKGROUND: Although the performance of adjuvant chemoradiotherapy (ACRT) for resected gallbladder cancer may improve the survival for certain patients, its impact on the survival in early-stage resected gallbladder adenocarcinoma (GBAC) patients remains underexplored. This study aimed to determine the ACRT effects on the survival of early-stage resected GBAC patients. METHODS: Patients with early-stage resected GBAC diagnosed between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The covariables included gender, age, race, tumor differentiation, TNM stage (AJCC TNM staging system, 7th edition), adjuvant radiotherapy (ART), and adjuvant chemotherapy (ACT). The effects of ACRT on survival were evaluated by univariate and multivariate analysis. RESULTS: A total of 1,586 patients with resected GBAC met the inclusion criteria were included in this study. Patients who received ACT were older, with poorer tumor differentiation or higher TNM stage (all p < 0.05), while patients who underwent ART were proved to be significantly correlated with poorer tumor differentiation (p = 0.010) and higher TNM stage (p < 0.001). Univariate and multivariate analysis of overall survival (OS) showed that age (p < 0.001; HR, 2.039; 95% CI, 1.718-2.420), tumor grade (p < 0.001; HR, 1.887; 95% CI, 1.530-2.370), and AJCC 7th TNM stage (p < 0.001; HR, 1.417; 95% CI, 1.182-1.699) were independent prognostic risk factors. Interestingly, ART and ACT were not independently associated with improved OS in the overall cohort analysis. However, when patients were subgrouped according to tumor differentiation, ART (p = 0.049; HR, 0.639; 95% CI, 0.409-0.999) has been identified as a significant prognostic factor for grade III/IV patients. Meanwhile, ARC (p = 0.011; HR, 0.739; 95% CI, 0.586-0.932) was associated with improved OS among tumor stage II patients (p<0.001). CONCLUSION: ACRT may have specific survival benefits for early-stage resected GBAC patients. ART can improve survival in patients with poor or absent tumor differentiation. Besides, patients with tumor invasion beyond muscularis (stage II tumor) may benefit from ACT. Our study provides supporting evidence for the clinical applications of ACRT in early-stage GBAC patients.
BACKGROUND: Although the performance of adjuvant chemoradiotherapy (ACRT) for resected gallbladder cancer may improve the survival for certain patients, its impact on the survival in early-stage resected gallbladder adenocarcinoma (GBAC) patients remains underexplored. This study aimed to determine the ACRT effects on the survival of early-stage resected GBAC patients. METHODS: Patients with early-stage resected GBAC diagnosed between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The covariables included gender, age, race, tumor differentiation, TNM stage (AJCC TNM staging system, 7th edition), adjuvant radiotherapy (ART), and adjuvant chemotherapy (ACT). The effects of ACRT on survival were evaluated by univariate and multivariate analysis. RESULTS: A total of 1,586 patients with resected GBAC met the inclusion criteria were included in this study. Patients who received ACT were older, with poorer tumor differentiation or higher TNM stage (all p < 0.05), while patients who underwent ART were proved to be significantly correlated with poorer tumor differentiation (p = 0.010) and higher TNM stage (p < 0.001). Univariate and multivariate analysis of overall survival (OS) showed that age (p < 0.001; HR, 2.039; 95% CI, 1.718-2.420), tumor grade (p < 0.001; HR, 1.887; 95% CI, 1.530-2.370), and AJCC 7th TNM stage (p < 0.001; HR, 1.417; 95% CI, 1.182-1.699) were independent prognostic risk factors. Interestingly, ART and ACT were not independently associated with improved OS in the overall cohort analysis. However, when patients were subgrouped according to tumor differentiation, ART (p = 0.049; HR, 0.639; 95% CI, 0.409-0.999) has been identified as a significant prognostic factor for grade III/IV patients. Meanwhile, ARC (p = 0.011; HR, 0.739; 95% CI, 0.586-0.932) was associated with improved OS among tumor stage II patients (p<0.001). CONCLUSION: ACRT may have specific survival benefits for early-stage resected GBAC patients. ART can improve survival in patients with poor or absent tumor differentiation. Besides, patients with tumor invasion beyond muscularis (stage II tumor) may benefit from ACT. Our study provides supporting evidence for the clinical applications of ACRT in early-stage GBAC patients.
Authors: Samuel J Wang; Andrew Lemieux; Jayashree Kalpathy-Cramer; Celine B Ord; Gary V Walker; C David Fuller; Jong-Sung Kim; Charles R Thomas Journal: J Clin Oncol Date: 2011-11-07 Impact factor: 44.544
Authors: A Duffy; M Capanu; G K Abou-Alfa; D Huitzil; W Jarnagin; Y Fong; M D'Angelica; R P Dematteo; L H Blumgart; E M O'Reilly Journal: J Surg Oncol Date: 2008-12-01 Impact factor: 3.454
Authors: Douglas G Gold; Robert C Miller; Michael G Haddock; Leonard L Gunderson; Fernando Quevedo; John H Donohue; Sumita Bhatia; David M Nagorney Journal: Int J Radiat Oncol Biol Phys Date: 2009-03-16 Impact factor: 7.038
Authors: William R Jarnagin; Leyo Ruo; Sarah A Little; David Klimstra; Michael D'Angelica; Ronald P DeMatteo; Raquel Wagman; Leslie H Blumgart; Yuman Fong Journal: Cancer Date: 2003-10-15 Impact factor: 6.860
Authors: Edgar Ben-Josef; Katherine A Guthrie; Anthony B El-Khoueiry; Christopher L Corless; Mark M Zalupski; Andrew M Lowy; Charles R Thomas; Steven R Alberts; Laura A Dawson; Kenneth C Micetich; Melanie B Thomas; Abby B Siegel; Charles D Blanke Journal: J Clin Oncol Date: 2015-05-11 Impact factor: 50.717