Concurrent Chemoradiotherapy in Curatively Resected Gallbladder Carcinoma: A Propensity Score–Matched Analysis

Gu, Benxing; Qian, Lijun; Yu, Hong; Hu, Jianbin; Wang, Qi; Shan, Jingjing; Shi, Lei; Liu, Hai; Yang, Qing; Liang, Xiao; Cai, Xiujun; Sun, Xin

doi:10.1016/j.ijrobp.2017.09.029

Cited by 17 publications

(15 citation statements)

References 35 publications

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“…In addition to the randomised phase III study by Takada and colleagues, (14), adjuvant radiotherapy (72,(134)(135)(136) and chemo-radiotherapy (45,69,74,(137)(138)(139) for resected GBC have been explored in multiple phase II and retrospective studies. The largest series was from SEER including 3,187 patients with GBC which showed that adjuvant radiotherapy was associated with improved OS (14 vs. 8 months; p≤0.001) (135).…”

Section: Other Non-randomised Studies Focused On Gbcmentioning

confidence: 99%

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Current standards and future perspectives in adjuvant treatment for biliary tract cancers

Lamarca

Edeline

McNamara

et al. 2020

Cancer Treatment Reviews

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Biliary tract cancer, including cholangiocarcinoma (CCA) and gallbladder cancer (GBC) are rare tumours with a rising incidence. Prognosis is poor, since most patients are diagnosed with advanced disease. Only ~20% of patients are diagnosed with early-stage disease, suitable for curative surgery.Despite surgery performed with potentially-curative intent, relapse rates are high, with around 60-70% of patients expected to have disease recurrence. Most relapses occur in the form of distant metastases, with a predominance of liver spread. In view of high tumour recurrence, adjuvant strategies have been explored for many years, in the form of radiotherapy, chemo-radiotherapy and chemotherapy. Historically, few randomised trials were available, including a variety of additional tumours (e.g. pancreatic and ampullary tumours) and most evidence relied on phase II and retrospective studies, with no high-quality evidence available to define the real benefit derived from adjuvant strategies.Since 2017, three randomised phase III clinical trials have been reported; all recruited patients with resected biliary tract cancer (CCA and GBC) who were randomised to observation alone, or chemotherapy in the form of gemcitabine (BCAT study; included patients diagnosed with extrahepatic CCA only), gemcitabine and oxaliplatin (PRODIGE-12/ACCORD-18; included patients diagnosed with CCA and GBC) or capecitabine (BILCAP; included patients diagnosed with CCA and GBC). While gemcitabine-based chemotherapy failed to show an impact on patient outcome (relapse-free survival (RFS) or overall survival (OS)), the BILCAP study showed a benefit from adjuvant capecitabine in terms of OS (pre-planned sensitivity analysis in the intention-to-treat population and in the per-protocol analysis), with confirmed benefit in terms of RFS. Based on the BILCAP trial, international guidelines recommend adjuvant capecitabine for a period of six months following potentially curative resection of CCA as the current standard of care for resected CCA and GBC. However, BILCAP failed to show OS benefit in the intention-to-treat (non-sensitivity analysis) population (primary end-point), and this finding, as well as some inconsistencies between studies has been criticised and has led to confusion in the biliary tract cancer medical community. This review summarises the adjuvant field in biliary tract cancer, with evidence before and after 2017, and comparison between the latest randomised phase III studies. Potential explanations are presented for differential findings, and future steps are explored.

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Section: Other Non-randomised Studies Focused On Gbcmentioning

confidence: 99%

“…69 in the MF group and 43 in the control group). The study showed evidence of benefit for the GBC group only, both in terms of OS (5-year OS rate was 26.0% (MF group) 14.4% (control group); p-value 0.0367) and disease-free survival (RFS) (5-year OS rate was 20.3% (MF group) 11.6% (control group); p-value 0.0210).…”

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confidence: 92%

Current standards and future perspectives in adjuvant treatment for biliary tract cancers

Lamarca

Edeline

McNamara

et al. 2020

Cancer Treatment Reviews

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“…According to data from the Surveillance, Epidemiology, and End Results (SEER) database, 97.3% of patients with GBC are middle-aged (older than 45), so the evaluation of good prognosis in this patient group is urgent. Although many studies have reported some prognostic factors for GBC, including age, TNM stage, tumor size, adjuvant therapy, and pathological grade, there has not yet been a population-based study that has systematically clarified postoperative patients over 45 years of age [ 6 , 8 , 9 ]. The 8 th edition of the AJCC TNM staging system has just been put into clinical use, so it is urgent to establish a prediction model based on this staging system to assist in daily clinical use [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic Evaluation for Patients over 45 Years Old with Gallbladder Adenocarcinoma Resection: A SEER-Based Nomogram Analysis

Song

2020

BioMed Research International

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Gallbladder adenocarcinoma is the main histopathological type of gallbladder cancer (GBC), so it is particularly important to understand its biological characteristics. Due to the low incidence of this type of cancer, there are few studies with large sample sizes. The log of positive lymph nodes (LODDS) has been evaluated by many scholars as a lymph node stage that may play a better role than the 8th edition of the American Joint Committee on Cancer (AJCC) lymph node staging system in many cancers. However, the effect of LODDS has not been proven in gallbladder adenocarcinoma. Our research aimed to identify independent prognostic factors that are closely related to overall survival (OS) in patients with gallbladder adenocarcinoma over 45 years of age using data from the Surveillance, Epidemiology and, End Results (SEER) database. All patients were randomly divided into a modeling cohort and an internal validation cohort. Seven independent prognostic factors associated with OS—age, marital status, grade, tumor size, AJCC 8th edition T stage and M stage, and LODDS—were used to build a nomogram to predict 1-, 3-, and 5-year survival. The C-index of our nomogram was 0.735 (95% CI, 0.716 to 0.754), and together with the calibration curve and ROC curve validation, the results confirmed the prediction effect of our nomogram. We believe that our nomogram will be an accurate and convenient method for patient prognosis assessment in the future.

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“…However, these clinical trials enrolled patients with GBC and other biliary tract cancers and did not document the therapeutic differences between CT and CRT. Meanwhile, several retrospective studies have reported contrasting outcomes regarding the role of adjuvant therapy in GBC [8-10]. Therefore, due to limited clinical evidence, adjuvant therapy is not specifically recommended for a particular type of GBC and the preferred option is not proffered by the National Comprehensive Cancer Network (NCCN) [11].…”

Section: Introductionmentioning

confidence: 99%

Adjuvant Therapy in Resected Nonmetastatic Stage II–IV Gallbladder Cancer: A Generalized Propensity Score Analysis

et al. 2021

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Background: The clinical benefits and efficacies of adjuvant therapies for gallbladder cancer (GBC) have not been verified due to insufficient clinical evidence. Methods: Patients with resected nonmetastatic stage II–IV GBC were selected from the Surveillance, Epidemiology, and End Results database and distributed into nonchemotherapy and chemoradiotherapy (NCRT), chemotherapy (CT), and chemoradiotherapy (CRT) groups. Generalized propensity score and inverse probability of treatment weighting (IPTW) were used to reduce the imbalances between groups. Results: A total of 2,689 patients were enrolled, among whom 1,193 (44.4%) were classified as stage II, 1,371 (51.0%) as stage III, and 125 (4.6%) as stage IV GBC. A total of 1,703, 444, and 542 patients were placed in the NCRT, CT, and CRT groups, respectively. After the IPTW, there were no significant differences in overall survival (OS) between the 3 treatment groups (p > 0.05) in stage II GBC patients. In patients with stage III–IV GBC, the CT group exhibited a superior OS compared to the NCRT group (p < 0.001). In addition, the CRT group exhibited a superior OS compared to the CT (p < 0.001) and NCRT (p < 0.001) groups. For patients with stage III–IV tumors, a nomogram was constructed to predict the survival benefits of adjuvant therapies. Conclusion: Patients with stage II GBC may not benefit from adjuvant therapy, while patients with stage III–IV GBC were shown to benefit from chemotherapy and chemoradiotherapy. Furthermore, chemoradiotherapy exhibited a superior OS. Nevertheless, the results need to be explained in the context of retrospective studies.

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Concurrent Chemoradiotherapy in Curatively Resected Gallbladder Carcinoma: A Propensity Score–Matched Analysis

Cited by 17 publications

References 35 publications

Current standards and future perspectives in adjuvant treatment for biliary tract cancers

Current standards and future perspectives in adjuvant treatment for biliary tract cancers

Prognostic Evaluation for Patients over 45 Years Old with Gallbladder Adenocarcinoma Resection: A SEER-Based Nomogram Analysis

Adjuvant Therapy in Resected Nonmetastatic Stage II–IV Gallbladder Cancer: A Generalized Propensity Score Analysis

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