Background: Bone metastasis (BM) prevalence is underreported in biliary tract cancers (BTC). This study aimed to assess BM prevalence in a real-world BTC population, alongside examining its relationship to prognosis and genomic alterations.Methods: Patients with histology-proven BTC as reviewed at a university cancer centre between January 2019 and August 2022 were assessed. Data extracted from records included BTC subtype, molecular profiling and systemic anti-cancer therapy (SACT) use. Stratification by BTC subtype and metastasis sites occurred. Median overall survival (mOS) was defined as time from relapse or metastases to death. Survival analysis was conducted using the Cox Proportional Hazard model.Results: Of 197 patients, 74 (37.6%) had intrahepatic and 67 (34%) had extrahepatic cholangiocarcinoma. Thirty-four patients had BM (17.3%), with 14 identified at initial diagnosis. OS was not influenced by bone (HR 1.15;p= 0.48) or liver metastases (HR 1.09;p= 0.6). Stratifying for age and gender, no significant difference in OS was observed. Actionable alterations were equally likely in patients with (52.4%) and without BM (58.5%). Age of BTC onset (<65 or ≥65) did not significantly influence prevalence of actionable alterations. Patients receiving matched, targeted SACT had a mOS of 29.9 months, compared to 13.3 months in those with actionable alterations but no SACT matching (HR 0.35;p< 0.005).Conclusions: In advanced BTC, BM do not affect OS. Across all cohorts, actionable alterations improved OS when treated with matched SACT.
背景：胆道癌（BTC）中骨转移（BM）的患病率存在漏报。本研究旨在评估真实世界BTC人群中BM的患病率，并探讨其与预后及基因组改变的关系。 方法：对2019年1月至2022年8月期间在一所大学癌症中心经组织学确诊的BTC患者进行评估。从病历中提取的数据包括BTC亚型、分子谱分析和全身抗癌治疗（SACT）使用情况。按BTC亚型和转移部位进行分层。中位总生存期（mOS）定义为从复发或转移至死亡的时间。采用Cox比例风险模型进行生存分析。 结果：在197例患者中，74例（37.6%）为肝内胆管癌，67例（34%）为肝外胆管癌。34例患者发生BM（17.3%），其中14例在初诊时即发现。骨转移（HR 1.15；p=0.48）或肝转移（HR 1.09；p=0.6）均未影响总生存期。按年龄和性别分层后，总生存期未见显著差异。伴有BM的患者（52.4%）与不伴有BM的患者（58.5%）发生可干预基因改变的可能性相当。BTC发病年龄（<65岁或≥65岁）对可干预基因改变的患病率无显著影响。接受匹配靶向SACT治疗的患者mOS为29.9个月，而具有可干预基因改变但未接受匹配SACT治疗的患者mOS为13.3个月（HR 0.35；p<0.005）。 结论：在晚期BTC中，BM不影响总生存期。在所有队列中，当可干预基因改变患者接受匹配SACT治疗时，总生存期得到改善。
Impact of Bone Metastases and Actionable Genetic Alterations in Biliary Tract Cancer
肿瘤(癌症)患者之家