Identification of Patients for Adjuvant Therapy After Resection of Carcinoma of the Extrahepatic Bile Ducts: A Propensity Score-Matched Analysis

摘要: Resectability rates for extrahepatic cholangiocarcinoma have increased over time, but long-term survival after resection alone with curative intent remains poor. Recent series suggest improved adjuvant therapy. Patient subsets benefiting most from therapy not been clearly defined. Patients who underwent and received (chemotherapy ± radiotherapy) or surgery (SA) were identified in the U.S. National Cancer Data Base (2004–2014). Cox regression covariates associated overall (OS). Adjuvant SA cohorts matched (1:1) by propensity scores based on hazard modeling. Overall was compared Kaplan–Meier estimates. Of 4872 patients, chemotherapy used frequently 2416 (49.6%), often conjunction radiotherapy (RT) (n = 1555, 64.4%). without RT increasingly cases higher T classification [reference: T1–2; T3: 1.36; 95% confidence interval (CI), 1.19–1.55; T4: 1.77; CI 1.38–2.26], nodal positivity [odds ratio (OR), 1.26; 1.01–1.56], lymphovascular invasion (OR 1.21; 1.01–1.46), margin-positive 1.85; 1.61–2.12), significant improvements OS each high-risk subset score-matched cohort. median hilar tumors (40.0 vs 30.6 months; p = 0.025) distal (33.0 30.3 months; p = 0.123). Chemoradiotherapy superior outcomes of [hazard (HR), 0.63; 0.42–0.94]. multimodality is patients resected features.