Introduction: Tumor-related liver failure (TRLF) is the most common cause of death in patients with intrahepatic cholangiocarcinoma (ICC). Though we previously showed that liver radiotherapy (L-RT) for locally advanced ICC is associated with less frequent TRLF and longer overall survival (OS), the role of L-RT for patients with extrahepatic metastatic disease (M1) remains undefined. We sought to compare outcomes for M1 ICC patients treated with and without L-RT. Methods: We reviewed ICC patients found to have M1 disease at initial diagnosis at a single institution between 2010 and 2021 who received L-RT, matching them with an institutional cohort by propensity score and a National Cancer Database (NCDB) cohort by frequency technique. The median biologically effective dose (BED10) was 98 Gy (interquartile range [IQR] 80.5-97.9 Gy) for L-RT. Patients treated with other local therapies or supportive care alone were excluded. We analyzed survival with Cox proportional hazards modeling. Results: We identified 61 patients who received L-RT and 220 who received chemotherapy alone. At median follow up of 11 months after diagnosis, median OS was 9 months (95% confidence interval [CI] 8-11) and 21 months (CI 17-26) for patients receiving chemotherapy alone and L-RT, respectively. TRLF was the cause of death more often in the patients who received chemotherapy alone compared to those who received L-RT (82% vs. 47%; P=0.001). On multivariable propensity-score matched analysis, associations with lower risk of death included duration of upfront chemotherapy (hazard ratio [HR] 0.82; P=0.005) and receipt of L-RT (HR 0.40; P=0.002). The median OS from diagnosis for NCDB chemotherapy alone cohort was shorter than that of the institutional L-RT cohort (9 vs. 22 months; P<0.001). Discussion/Conclusion: For M1 ICC, L-RT associated with a lower rate of death due to TRLF and longer OS vs. those treated with chemotherapy alone. Prospective studies of L-RT in this setting are warranted.


中文翻译：

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肝内胆管癌伴肝外转移的明确肝脏放疗

简介：肿瘤相关性肝衰竭（TRLF）是肝内胆管癌（ICC）患者最常见的死亡原因。尽管我们之前表明，局部晚期 ICC 的肝脏放疗 (L-RT) 与较少的 TRLF 发生率和较长的总生存期 (OS) 相关，但 L-RT 对于肝外转移性疾病 (M1) 患者的作用仍不清楚。我们试图比较接受和不接受 L-RT 治疗的 M1 ICC 患者的结果。方法：我们回顾了 2010 年至 2021 年间在单一机构初次诊断时发现患有 M1 疾病并接受 L-RT 的 ICC 患者，通过倾向评分将其与机构队列进行匹配，并通过频率技术将其与国家癌症数据库 (NCDB) 队列进行匹配。L-RT 的中位生物有效剂量 (BED10) 为 98 Gy（四分位数范围 [IQR] 80.5-97.9 Gy）。仅接受其他局部疗法或支持治疗的患者被排除在外。我们使用 Cox 比例风险模型分析了生存率。结果：我们确定了 61 名接受 L-RT 的患者和 220 名接受单纯化疗的患者。在诊断后 11 个月的中位随访中，接受单独化疗和 L-RT 的患者的中位 OS 分别为 9 个月（95% 置信区间 [CI] 8-11）和 21 个月（CI 17-26）。与接受 L-RT 的患者相比，TRLF 是仅接受化疗的患者更常见的死亡原因（82% vs. 47%；P=0.001）。在多变量倾向评分匹配分析中，与较低死亡风险的关联包括前期化疗持续时间（风险比 [HR] 0.82；P=0.005）和接受 L-RT（HR 0.40；P=0.002）。单独 NCDB 化疗队列的中位 OS 诊断时间短于机构 L-RT 队列（9 个月与 22 个月；P<0.001）。讨论/结论：对于 M1 ICC，与单独化疗的患者相比，L-RT 与较低的 TRLF 死亡率和较长的 OS 相关。在这种情况下 L-RT 的前瞻性研究是有必要的。