TY - JOUR
T1 - Treatment outcomes for unresectable intrahepatic cholangiocarcinoma
T2 - Nationwide, population-based, cohort study based on propensity score matching with the Mahalanobis metric
AU - Chang, Wei Wen
AU - Hsiao, Ping Kun
AU - Qin, Lei
AU - Chang, Chia Lun
AU - Chow, Jyh Ming
AU - Wu, Szu Yuan
N1 - Publisher Copyright:
© 2018 Elsevier B.V.
PY - 2018/11
Y1 - 2018/11
N2 - Purpose: No prospective randomized trials have been conducted to date to evaluate the efficacy of palliation of pain or jaundice without treatment, definitive concurrent chemoradiotherapy (CCRT), sequential chemotherapy and radiotherapy (CTRT), or chemotherapy (CT) alone for treating unresectable intrahepatic cholangiocarcinoma (ICC). We designed a nationwide, population-based, cohort study to determine the effects of different treatments on patients with unresectable ICC using propensity score matching (PSM) with the Mahalanobis metric. Patients and methods: We classified patients with unresectable ICC from the Taiwan Cancer Registry database into the following 4 treatment groups: group 1, definitive CCRT; group 2, sequential CTRT; group 3, no treatment (palliative therapy for relief of pain, pruritus, or jaundice); and group 4, CT alone. Confounding factors among the 4 treatment groups were minimized through propensity score matching (PSM). Results: After PSM, the final cohort consisted of 844 patients (211 patients in each of the 4 groups). In both univariable and multivariable Cox regression analyses, adjusted hazard ratios (aHRs; 95% confidence interval [CI]) derived for groups 1 and 2 compared with group 4 were 0.65 (0.59–0.71) and 0.95 (0.83–1.48), respectively. Furthermore, an aHR (95% CI) of 2.25 (1.89–2.67) was derived for significant independent prognostic risk factors for poor overall survival for group 3 compared with group 4. Conclusions: Definitive CCRT is the optimal therapy for patients with unresectable ICC without distant metastasis.
AB - Purpose: No prospective randomized trials have been conducted to date to evaluate the efficacy of palliation of pain or jaundice without treatment, definitive concurrent chemoradiotherapy (CCRT), sequential chemotherapy and radiotherapy (CTRT), or chemotherapy (CT) alone for treating unresectable intrahepatic cholangiocarcinoma (ICC). We designed a nationwide, population-based, cohort study to determine the effects of different treatments on patients with unresectable ICC using propensity score matching (PSM) with the Mahalanobis metric. Patients and methods: We classified patients with unresectable ICC from the Taiwan Cancer Registry database into the following 4 treatment groups: group 1, definitive CCRT; group 2, sequential CTRT; group 3, no treatment (palliative therapy for relief of pain, pruritus, or jaundice); and group 4, CT alone. Confounding factors among the 4 treatment groups were minimized through propensity score matching (PSM). Results: After PSM, the final cohort consisted of 844 patients (211 patients in each of the 4 groups). In both univariable and multivariable Cox regression analyses, adjusted hazard ratios (aHRs; 95% confidence interval [CI]) derived for groups 1 and 2 compared with group 4 were 0.65 (0.59–0.71) and 0.95 (0.83–1.48), respectively. Furthermore, an aHR (95% CI) of 2.25 (1.89–2.67) was derived for significant independent prognostic risk factors for poor overall survival for group 3 compared with group 4. Conclusions: Definitive CCRT is the optimal therapy for patients with unresectable ICC without distant metastasis.
KW - Chemotherapy alone
KW - Concurrent chemoradiotherapy
KW - Intrahepatic cholangiocarcinoma
KW - Sequential chemoradiotherapy
KW - Survival
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U2 - 10.1016/j.radonc.2018.09.010
DO - 10.1016/j.radonc.2018.09.010
M3 - Article
AN - SCOPUS:85054061402
SN - 0167-8140
VL - 129
SP - 284
EP - 292
JO - Radiotherapy and Oncology
JF - Radiotherapy and Oncology
IS - 2
ER -