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Adjuvant therapy in the treatment of gallbladder cancer: a meta-analysis.

Ma N, Cheng H, Qin B, Zhong R, Wang B - BMC Cancer (2015)

Bottom Line: There was a nonsignificant improvement in OS with AT compared with surgery alone (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.56-1.03).A significant improvement was observed in OS with chemotherapy (CT) compared with surgery alone (HR, 0.42; 95% CI, 0.22-0.80) by sensitivity analysis.Moreover, patients with node positivity, margin positivity, or non-stage I disease are more likely to benefit from AT.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200041, China. mamimg@sina.com.

ABSTRACT

Background: The benefit of adjuvant therapy (AT) for gallbladder cancer (GBC) is unclear as evidenced by conflicting results from nonrandomized studies. Here we aimed to perform a meta-analysis to determine the impact of AT on overall survival (OS).

Methods: We used data from MEDLINE, EMBASE and the Cochrane Collaboration Library and published between October 1967 and October 2014. Studies that evaluated AT compared with curative-intent surgery alone for resected GBC were included. Subgroup analyses of benefit based on node status, margins status, and American Joint Committee on Cancer (AJCC) staging were prespecified. Data were weighted and pooled using random-effect modeling.

Results: Ten retrospective studies involving 3,191 patients were analyzed. There was a nonsignificant improvement in OS with AT compared with surgery alone (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.56-1.03). A significant improvement was observed in OS with chemotherapy (CT) compared with surgery alone (HR, 0.42; 95% CI, 0.22-0.80) by sensitivity analysis. The greatest benefit for AT was also observed in those with R1 disease (HR, 0.33; 95% CI, 0.19-0.59), LN-positive disease (HR, 0.71; 95% CI, 0.63-0.81), and AJCC staging meeting or exceeding tumor Stage II (HR, 0.45; 95% CI, 0.26-0.79), but not in those with LN-negative or R0 disease.

Conclusion: Our results strongly support the use of CT as an AT in GBC. Moreover, patients with node positivity, margin positivity, or non-stage I disease are more likely to benefit from AT.

No MeSH data available.


Related in: MedlinePlus

Flow chart showing the progress of trials through the review
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Related In: Results  -  Collection

License 1 - License 2
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Fig1: Flow chart showing the progress of trials through the review

Mentions: The relevant clinical trials were manually selected carefully based on the following criteria: (1) case–control design of non-randomized study; (2) patients diagnosed with GBC according to histopathological or cytological evidence; (3) patients underwent AT defined as CT, RT, or both administered after curative-intent surgery, and patients who underwent curative-intent surgery alone as a comparator group should be included in those studies; (4) information collected including hazard ratio (HR) for OS along with 95 % confidence interval (CI) or relevant data. When searched references referred to the same studies, the more recently published and larger studies were included. We also defined curative-intent resections as no gross disease remaining (i.e., negative margins [R0] or microscopic positive margins [R1]), thus excluding macroscopic involvement (R2) resections [6]. The procedure of inclusion and exclusion criteria of the evaluated studies was listed in Fig. 1.Fig. 1


Adjuvant therapy in the treatment of gallbladder cancer: a meta-analysis.

Ma N, Cheng H, Qin B, Zhong R, Wang B - BMC Cancer (2015)

Flow chart showing the progress of trials through the review
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4559875&req=5

Fig1: Flow chart showing the progress of trials through the review
Mentions: The relevant clinical trials were manually selected carefully based on the following criteria: (1) case–control design of non-randomized study; (2) patients diagnosed with GBC according to histopathological or cytological evidence; (3) patients underwent AT defined as CT, RT, or both administered after curative-intent surgery, and patients who underwent curative-intent surgery alone as a comparator group should be included in those studies; (4) information collected including hazard ratio (HR) for OS along with 95 % confidence interval (CI) or relevant data. When searched references referred to the same studies, the more recently published and larger studies were included. We also defined curative-intent resections as no gross disease remaining (i.e., negative margins [R0] or microscopic positive margins [R1]), thus excluding macroscopic involvement (R2) resections [6]. The procedure of inclusion and exclusion criteria of the evaluated studies was listed in Fig. 1.Fig. 1

Bottom Line: There was a nonsignificant improvement in OS with AT compared with surgery alone (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.56-1.03).A significant improvement was observed in OS with chemotherapy (CT) compared with surgery alone (HR, 0.42; 95% CI, 0.22-0.80) by sensitivity analysis.Moreover, patients with node positivity, margin positivity, or non-stage I disease are more likely to benefit from AT.

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200041, China. mamimg@sina.com.

ABSTRACT

Background: The benefit of adjuvant therapy (AT) for gallbladder cancer (GBC) is unclear as evidenced by conflicting results from nonrandomized studies. Here we aimed to perform a meta-analysis to determine the impact of AT on overall survival (OS).

Methods: We used data from MEDLINE, EMBASE and the Cochrane Collaboration Library and published between October 1967 and October 2014. Studies that evaluated AT compared with curative-intent surgery alone for resected GBC were included. Subgroup analyses of benefit based on node status, margins status, and American Joint Committee on Cancer (AJCC) staging were prespecified. Data were weighted and pooled using random-effect modeling.

Results: Ten retrospective studies involving 3,191 patients were analyzed. There was a nonsignificant improvement in OS with AT compared with surgery alone (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.56-1.03). A significant improvement was observed in OS with chemotherapy (CT) compared with surgery alone (HR, 0.42; 95% CI, 0.22-0.80) by sensitivity analysis. The greatest benefit for AT was also observed in those with R1 disease (HR, 0.33; 95% CI, 0.19-0.59), LN-positive disease (HR, 0.71; 95% CI, 0.63-0.81), and AJCC staging meeting or exceeding tumor Stage II (HR, 0.45; 95% CI, 0.26-0.79), but not in those with LN-negative or R0 disease.

Conclusion: Our results strongly support the use of CT as an AT in GBC. Moreover, patients with node positivity, margin positivity, or non-stage I disease are more likely to benefit from AT.

No MeSH data available.


Related in: MedlinePlus