临床外科杂志 ›› 2022, Vol. 30 ›› Issue (12): 1137-1141.doi: 10.3969/j.issn.1005-6483.2022.12.012

• 论著 • 上一篇    下一篇

术后辅助化疗对远端胆管癌病人预后的影响:基于SEER数据库的倾向评分匹配分析

  

  1. 430064 武汉科技大学附属天佑医院肝胆胰外科(石建文,王剑明);华中科技大学同济医学院附属同济医院小儿外科,湖北省先天性巨结肠及同源病临床医学研究中心(邓正栋);华中科技大学同济医学院附属同济医院胆胰外科(王剑明)
  • 收稿日期:2022-02-17 接受日期:2022-02-17 出版日期:2022-12-20 发布日期:2023-01-20
  • 通讯作者: 邓正栋,Email:dengzhengdong0915@163.com;王剑明,Email:wjm18jgm@aliyun.com

Effect of postoperative adjuvant chemotherapy on prognosis of patients with distal cholangiocarcinoma:a propensity score matching analysis based on SEER database

  1. Department of Hepatopancreatobiliry Surgery,Affiliated Tianyou Hospital,Wuhan University of Science & Technology,Wuhan 430064,China
  • Received:2022-02-17 Accepted:2022-02-17 Online:2022-12-20 Published:2023-01-20

摘要: 目的 分析术后辅助化疗对远端胆管癌(DCC)病人预后的影响。方法 回顾性分析SEER数据库2010~2015年行根治性手术治疗的455例DCC病人的临床资料。通过倾向评分匹配(PSM)减少组间偏倚,采用Kaplan-Meier法、Log-rank检验评估预后差异,Cox比例风险模型分析预后的独立危险因素。结果  应用PSM后,生存分析结果显示, TNM分期、辅助化疗及N分期与DCC病人的预后相关,术后辅助化疗是影响病人预后的独立危险因素。进一步亚组分析显示,在 Ⅰ期病人中,术后化疗组与单纯手术组的3年存活率与中位生存时间比较,差异无统计学意义(P>0.05),术后化疗组 Ⅱ期病人的预后优于单纯手术组(P<0.05);术后化疗可延长中分化和低/未分化病人的术后3年存活率与中位生存时间(P<0.05),而在高分化病人中术后化疗组与单纯手术组3年存活率与中位生存时间比较,差异无统计学意义(P>0.05);辅助化疗可延长淋巴结阳性病人的3年存活率与术后中位生存时间(P<0.05),但对淋巴结阴性病人的生存预后无明显改善(P>0.05)。结论 术后化疗与DCC病人长期生存获益相关,辅助化疗是影响其预后的独立危险因素。TNM分期 Ⅱ 期、病理中分化和低/未分化和淋巴结阳性的DCC病人为术后化疗的潜在受益人群。

关键词: 辅助化疗, 远端胆管癌, 预后, SEER数据库, 倾向评分匹配

Abstract: Objective To analyze the effect of postoperative adjuvant chemotherapy on prognosis of patients with distal cholangiocarcinoma(DCC).Methods Clinical data of 455 DCC patients who received radical surgical treatment from 2010 to 2015 were retrospectively analyzed in SEER database.Propensity score matching(PSM) was employed to reduce the bias,Kaplan-Meier test and Log-rank test were used to evaluate prognostic differences and Cox proportional risk model was used to analyze independent prognostic risk factors.Results  After PSM,it is found that TNM stage,postoperative chemotherapy and N stage were correlated with the prognosis of DCC patients,and postoperative adjuvant chemotherapy was an independent risk factor affecting the prognosis of patients.Further subgroup analysis showed that there were no significant difference in 3 year survival rate and  median survival time of DCC patients with stage Ⅰ between the postoperative chemotherapy group and the only surgery group(P>0.05),while the prognosis of patients with stage Ⅱ in the chemotherapy group was significantly better than that in the only surgery group(P<0.05).Postoperative chemotherapy could prolong the 3 year survival rate and median survival time of the moderately differentiated and poorly differentiated/undifferentiated patients(all P<0.05),while there were no significant differences in the 3 year survival rate and median survival time of the highly differentiated patients in the postoperative chemotherapy group and the only surgery group(P>0.05).Adjuvant chemotherapy could benlifit the 3 year survival rate and postoperative median survival time of patients with positive lymph nodes( P<0.05),but did not significantly improve the survival prognosis of patients with negative lymph nodes( P>0.05).Conclusion Postoperative chemotherapy is associated with long-term survival benefit of patients with distal cholangiocarcinoma,and it is an independent risk factor affecting prognosis.DCC patients with TNM stage Ⅱ,moderately differentiated and poorly differentiated/undifferentiated pathologically and lymph node positive status are potential beneficiaries of postoperative chemotherapy.

Key words: adjuvant chemotherapy, distal cholangiocarcinoma, prognosis, SEER database, propensity score matching(PSM)

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