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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

Efficacy outcomes for difference of country and cumulative meta-analysis over time. a. Different countries. b. Asian/non-Asian countries
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Fig4: Efficacy outcomes for difference of country and cumulative meta-analysis over time. a. Different countries. b. Asian/non-Asian countries

Mentions: AT were less adopted on GBC of Tumor, Node, Metastasis staging T1 N0M0/T2N0M0. As a result, the AJCC staging of most of patients in these 11 studies met or exceeded T2N1M0 or T3N0M0, which is stage II in the 6th AJCC staging system. Among these 11 studies, seven meeting or exceeding tumor stage II (n = 2,738) according to our prespecified definition (≥50 %) were analyzed independently [13, 15, 17–19, 21]. Pooled data confirmed a significant benefit for any AT in those patients (HR, 0.45; 95 % CI, 0.26–0.79; Fig. 4a). Subgroup analysis showed a significant improvement in survival with CT compared with surgery alone (HR, 0.21; 95 % CI, 0.05–0.88) but not with RT (HR, 0.48; 95 % CI, 0.17–1.40; Fig. 4a).Fig. 4


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

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

Efficacy outcomes for difference of country and cumulative meta-analysis over time. a. Different countries. b. Asian/non-Asian countries
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig4: Efficacy outcomes for difference of country and cumulative meta-analysis over time. a. Different countries. b. Asian/non-Asian countries
Mentions: AT were less adopted on GBC of Tumor, Node, Metastasis staging T1 N0M0/T2N0M0. As a result, the AJCC staging of most of patients in these 11 studies met or exceeded T2N1M0 or T3N0M0, which is stage II in the 6th AJCC staging system. Among these 11 studies, seven meeting or exceeding tumor stage II (n = 2,738) according to our prespecified definition (≥50 %) were analyzed independently [13, 15, 17–19, 21]. Pooled data confirmed a significant benefit for any AT in those patients (HR, 0.45; 95 % CI, 0.26–0.79; Fig. 4a). Subgroup analysis showed a significant improvement in survival with CT compared with surgery alone (HR, 0.21; 95 % CI, 0.05–0.88) but not with RT (HR, 0.48; 95 % CI, 0.17–1.40; Fig. 4a).Fig. 4

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