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Benefit of adjuvant radiotherapy for gallbladder cancer: a comparability-based meta-analysis

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Abstract

Background and purpose

The benefits of adjuvant radiotherapy (ART) in gallbladder cancer (GBC) treatment remain inconclusive owing to the rarity of GBC and lack of randomized studies.

Methods

PubMed, Medline, Embase, and Cochrane Library were systematically searched until March 2021. The primary endpoint was overall survival (OS). Comparative clinical studies that reported survival outcomes in GBC patients treated with or without ART were included. The comparability of each study was assessed by considering all possible clinical indicators (group 2: ART arm with poor clinical profile; group 1: ART arm with statistically similar profile or no evidence of having inferior clinical factors compared to non-ART arm).

Results

Twenty-one studies involving 6876 GBC patients were reviewed. In pooled analyses of OS, the odds ratio (OR) was 1.26 (p = 0.111) neither favoring ART or non-ART arms. In subgroup analyses considering comparability, the OR significantly favored the ART arm (1.92, p = 0.008) among comparability group 1 studies, whereas it was 1.03 (p = 0.865) in comparability group 2 studies. The pooled rate of 5-year OS in the ART vs. non-ART arms was 44.9% vs. 20.9% in group 1 and 34.1% vs. 40.0% in group 2. With ART, significant reduction in locoregional recurrence (OR 0.21, p = 0.001) but not in distant metastasis (OR 1.32, p = 0.332) was noted.

Conclusion

ART not only showed benefits in patients with a similar clinical profile to those treated without ART but also yielded comparable survival in patients with an inferior clinical profile. Our results suggest the more active application of ART in GBC treatment.

Protocol registration

This study is registered in PROSPERO (CRD42021240624, available at: https://www.crd.york.ac.uk/).

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Acknowledgements

We appreciate the dedicated contribution of Hu Jing Hua, MSc., who majored in Korean Language Translation at Chonnam National University, Jeollanamdo, Korea, for Chinese language translation.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (NRF-2019M2D2A1A01031560 and NRF-2021R1A2C1010900). The research grant supported only methodological aspects, including statistical analysis and linguistic correction, and did not influence major contents such as results and conclusions.

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Authors and Affiliations

  1. Department of Radiation Oncology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Korea

    Seo Hee Choi

  2. Department of Radiation Oncology, Korea University Ansan Hospital, Korea University Medical College, 123 Jeokgeum-ro, Danwon-gu, Ansan, Gyeonggi-do, 15355, Republic of Korea

    Chai Hong Rim & Won Sup Yoon

  3. Graduate School of Education, AI Convergence Education, Dongguk University, Seoul, Korea

    In-Soo Shin

  4. Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Medical College, Seoul, Korea

    Woong Sub Koom & Jinsil Seong

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  1. Seo Hee Choi
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Contributions

SHC, writing (original draft), data curation; I-SS, formal analysis, data curation, methodology; JS, writing (editing), supervision; WSK, W-SY, supervision; CHR, conceptualization, writing (original draft, review, and editing), formal analysis, data curation.

Corresponding author

Correspondence to Chai Hong Rim.

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Conflict of interest

Seo Hee Choi, Chai Hong Rim, In-Soo Shin, Won Sup Yoon, Woong Sub Koom, Jinsil Seong have any conflicts of interest to disclose.

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The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Protocol registration

This study is registered in PROSPERO (CRD42021240624, available at: https://www.crd.york.ac.uk/).

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Choi, S.H., Rim, C.H., Shin, IS. et al. Benefit of adjuvant radiotherapy for gallbladder cancer: a comparability-based meta-analysis. Hepatol Int 16, 712–727 (2022). https://doi.org/10.1007/s12072-022-10343-6

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