A meta-analysis of the efficacy of postoperative adjuvant radiotherapy and non-radiotherapy for extrthepatic cholangiocarcinoma and gallbladder carcinoma

Objective: To compare the efficacy of postoperative adjuvant radiotherapy and non-radiotherapy in patients with extrthepatic cholangiocarcinoma and gallbladder carcinoma by a meta-analysis. Methods: The controlled clinical trials of postoperative adjuvant radiotherapy versus non-radiotherapy of extrthepatic cholangiocarcinoma and gallbladder carcinoma were searched from PubMed, EMbase, Cochrane Library, Wanfang database, CNKI, Chongqing VIP and CBM databases. The obtained data were analyzed using RevMan 5. 3 and Stata 14. 0 statistical software. The difference between two groups was estimated by calculating the odds ratio (OR) with 95% confidence interval (CI). Results: A total of 20 controlled clinical trials involving 1258 extrthepatic cholangiocarcinoma and gallbladder carcinoma patients were included in this meta-analysis. The meta-analysis demonstrated that the 5- year survival rate in the adjuvant radiotherapy group was significantly higher than that in the non-radiotherapy group (OR = 1.67, 95% CI: 1.29-2.18, P = 0.001). The 5- year survival rates in those with lymph node positive disease (OR = 7.44, 95% CI: 1.24-44.72, P = 0.03) and positive margins disease (OR = 3.43, 95% CI: 1.56-7.75, P = 0.002) were significantly enhanced by postoperative adjuvant radiotherapy. The local recurrence rate in the adjuvant radiotherapy group was significantly lower than that in the non-radiotherapy group (OR = 0.56, 95% CI: 0.39-0.80, P = 0.01), whereas the distant metastasis rate did not significantly differ between two groups (OR = 1.22, 95% CI: 0.86-1.73, P = 0.27). The incidence rates of acute toxicity and chronic toxicity of grade ≥ 3 caused by radiotherapy were 0-11.9% and 0-21.7%, respectively. Conclusion: Compared with non-radiotherapy, postoperative adjuvant radiotherapy is a safer and more effective postoperative treatment for extrthepatic cholangiocarcinoma and gallbladder carcinoma. (authors)