周術期化学療法 vs. 前方手術：門脈部胆管癌に対する傾向スコアマッチング解析
Keita Sonoda1, Yuta Abe1, Naokazu Chiba2
1Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Background:
Neoadjuvant chemotherapy (NAC) may improve outcomes in perihilar cholangiocarcinoma (PHC); however, its efficacy compared with upfront surgery (US) for resectable PHC remains unclear. We compared survival and clinicopathological characteristics between NAC and US in patients with technically resectable PHC, using propensity score matching (PSM).
Methods:
We retrospectively analyzed 261 patients with resectable PHC who underwent surgical treatment (2016-2024) across multiple institutions. Among them, 50 received NAC and 199 underwent US. The 38 patients receiving NAC were matched 1:1 with patients undergoing US using PSM. Overall survival (OS) and progression-free survival (PFS) were compared between groups. Pathological response to NAC and its association with chemotherapy doses were also evaluated.
Results:
Before PSM, OS and PFS did not differ significantly between the US and NAC groups. After PSM, OS did not differ significantly between groups, but PFS was significantly longer in the NAC group, where patients with a therapeutic-effect grade ≥1b had better PFS than those with US. Grade ≥1b response was associated with receiving ≥7 NAC doses.
Discussion:
NAC may improve PFS in selected patients with resectable PHC, especially those showing major pathological responses. Prospective studies should validate these findings and define optimal selection criteria and regimens.
