Concurrent Chemoradiotherapy in Curatively Resected Gallbladder Carcinoma : A propensity score-matched analysis
Menée auprès de 94 patients atteints d'un carcinome de la vésicule biliaire de stade pT2-4N0-1M0 traité par résection, cette étude évalue, du point de vue de la survie globale à 1, 3 et 5 ans, l'intérêt d'une chimioradiothérapie concomitante après l'intervention chirurgicale
Résumé en anglais
Purpose : The efficacy and safety of concurrent chemoradiotherapy (CCRT) in patients with advanced gallbladder carcinoma (GBC) after radical resection (S) remains unclear . The primary aim was to compare overall survival (OS) between patients receiving radical resection followed by CCRT (S+CCRT) and patients receiving radical resection only for advanced resectable GBC.
Methods and Materials : 94 GBC patients with stage pT2-4, N0-1, and M0 consented to inclusion in a clinical database from June 2003 to July 2013. Patients who received S+CCRT were matched by propensity score with those who received S through nearest neighbor matching with a caliper width of 0.2 to ensure similar baseline characteristics between each group. The effect of CCRT on OS and disease free survival (DFS) were evaluated with Kaplan Meier analysis. Cox proportional hazards regression was performed on the entire cohort. Adverse effects and oncological outcomes were assessed.
Results : 78 patients with GBC ( 39 S+CCRT; 39 S) were matched based on propensity score, the 1-year, 3-year, and 5-year OS was 74.4%, 56.4%, and 42.4% for the S+CCRT group, and 51.3%, 30.8%, and 17.9% for the S group. The median survival time was 27 months (IQR, 12 - 58) for S+CCRT group vs. 13 months (IQR, 5 - 30) for the S group (P = 0.004), with the 1-year and 3-year DFS being 59.0% vs. 35.9% and 48.7% vs. 13.5% respectively, and the median DFS being 23 months (IQR, 8 - 57) vs. 7 months (IQR, 4 - 23) (P = 0.004).
Conclusion : The OS of matched patients with stage II to IVA GBC is significantly improved by CCRT. Radiotherapy combined with single-agent or dual-agent chemotherapy was feasible and well tolerated.
