Background: Biliary tract cancers (BTCs) have distinct tumor biology but share a poor prognosis, with a 5-year-survival-rate of 5–19%. Surgical resection is the only potential cure, but recurrences are common. The role of adjuvant radiotherapy (XRT) remains unclear.Methods: Using the National Cancer Database (2006–2018), we analyzed resected non-metastatic BTCs. Patients who survived beyond 90 days post-surgery were included, while those with R2 resections or neoadjuvant therapy were excluded. Propensity matching was performed based on predictors of adjuvant radiation, age, and sex. Survival outcomes were compared between no adjuvant therapy, chemotherapy alone, and XRT ± chemotherapy.Results: Among 21,275 patients, including 5308 intrahepatic cholangiocarcinoma (IHC), 2689 perihilar cholangiocarcinoma (PHC), 3092 distal cholangiocarcinoma (DCC), and 10,186 gallbladder cancer (GBC) cases, adjuvant XRT did not improve survival for IHC. For PHC and DCC, XRT improved survival over no adjuvant therapy (PHC: 31.2 vs. 26.3 months,p= 0.004; DCC: 33.7 vs. 27.0 months,p= 0.015) but not over chemotherapy alone. For GBC, XRT significantly improved survival compared to both no adjuvant therapy and chemotherapy (30.2 vs. 26.6 and 24.6 months;p= 0.05 andp= 0.001).Conclusions: XRT provides a survival benefit for GBC, especially in node-positive and R1-resected patients. For PHC and DCC, XRT improves outcomes compared to no therapy, but its benefit over chemotherapy is uncertain. No benefit was observed for IHC.
背景：胆道癌具有独特的肿瘤生物学特性，但总体预后较差，5年生存率仅为5%-19%。手术切除是唯一可能实现治愈的手段，但术后复发较为常见。辅助性放疗在胆道癌治疗中的作用尚不明确。 方法：本研究利用美国国家癌症数据库（2006-2018年）数据，对接受手术切除的非转移性胆道癌患者进行分析。纳入术后生存超过90天的患者，排除R2切除或接受新辅助治疗者。根据辅助放疗的预测因素、年龄和性别进行倾向性匹配。比较无辅助治疗、单纯化疗以及放疗（联合或不联合化疗）三组患者的生存结局。 结果：在21,275例患者中（包括5,308例肝内胆管癌、2,689例肝门部胆管癌、3,092例远端胆管癌和10,186例胆囊癌），辅助放疗未能改善肝内胆管癌患者的生存期。对于肝门部胆管癌和远端胆管癌，放疗较无辅助治疗可改善生存（肝门部胆管癌：31.2个月 vs 26.3个月，p=0.004；远端胆管癌：33.7个月 vs 27.0个月，p=0.015），但相较于单纯化疗未显示优势。对于胆囊癌，放疗较无辅助治疗和单纯化疗均显著改善生存期（30.2个月 vs 26.6个月和24.6个月；p=0.05和p=0.001）。 结论：放疗可为胆囊癌患者带来生存获益，尤其对淋巴结阳性及R1切除患者。对于肝门部胆管癌和远端胆管癌，放疗较无治疗可改善预后，但其相对于化疗的优势尚不确定。放疗对肝内胆管癌患者未观察到生存获益。
肿瘤(癌症)患者之家