Abstract
BackgroundThe distant metastasis (DM) mode and treatment efficacies in the advanced biliary tract cancer (BTC) were obscure, and a credible evaluation is urgently needed.MethodA total of 6348 advanced BTC patients (ICC, intrahepatic cholangiocarcinoma, n = 1762; PHCC, perihilar cholangiocarcinoma, n = 1103; GBC, gallbladder cancer, n = 2580; DCC, distal cholangiocarcinoma, n = 538; AVC, carcinoma of Vater ampulla, n = 365) were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) process was carried out for less bias.ResultThe proportion of M1 patients in each subtype at first diagnosis was 26.4% (ICC), 37.2% (PHCC), 41. 0% (GBC), 24.5% (DCC), and 12.7% (AVC), and the constitution of DM sites in different subtypes varied apparently. Moreover, the survival of metastasis sites was different (P < .05 in all the subtypes) where the multi‐metastasis and distant lymph node (dLN) only always indicated the worst and best prognosis, respectively. Chemotherapy presented the most significant survival impact with the lowest hazard ratio by multivariate cox model and still provided a survival improvement after PSM (all P < .001) in all subtypes. However, the median months manifested different between patients with and without chemotherapy among the subtypes (ICC, from 5 to 9; PHCC, from 6 to 10; AVC, from 4 to 9; GBC, from 6 to 7; DCC from 6 to 8).ConclusionWe provided a landscape about the detailed DM mode of the advanced BTC in a large population, found the survival differences among DM sites, and revealed the different chemotherapy efficacies in the BTC subtypes.
Highlights
Biliary system is a tree-like network of tubular structures, and could be classified into five segments according to the anatomic position, which are intrahepatic bile duct, hilar bile duct, gallbladder, distal bile duct, and ampulla of Vater from distal to proximal, respectively
Note that patients who died within 2 months after initial diagnosis confirmed or received radiation or palliative surgery were excluded in the propensity score matching (PSM) process for less bias in the cohort 2
Chemotherapy was the main choice at present, and it proved to be a significant method to prolong patient survival in multivariate cox model (yes vs no: intrahepatic cholangiocarcinoma (ICC), hazard ratio (HR) (95%Confidence interval (CI)): 0.274 (0.243-0.310), P < .001; perihilar cholangiocarcinoma (PHCC), HR (95%CI): 0.381 (0.330-0.438), P < .001; gallbladder cancer (GBC), HR (95%CI): 0.403 (0.367-0.443), P < .001; distal cholangiocarcinoma (DCC), (95%CI): 0.350 (0.285-0.429), P < .001; Carcinoma of Vater ampulla (AVC), HR (95%CI), 0.309 (0.234-0.409), P < .001)
Summary
Clinical Study of Zhongshan Hospital, Grant/Award Number: 2018ZSLC24; Science and Technology Commission of Shanghai Municipality, Grant/Award Number: 16411952000; the Shanghai Medical Discipline of Key Programs for General Surgery, Grant/Award Number: 2017ZZ02007; National Natural Science Foundation of China, Grant/Award Number: 81872352; JianFeng project of XuHui Provincial Commission of Health and Family Planning, Grant/Award Number: SHXH201703
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