Cholangiocarcinoma - A spectrum of intrahepatic, perihilar, and distal tumors
Cholangiocarcinoma - A spectrum of intrahepatic, perihilar, and distal tumors
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DOI：
10.1097/00000658-199610000-00005
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发表时间：
1996-10-01
影响因子：
9
通讯作者：
Cameron, JL
中科院分区：
文献类型：
--
作者：
Nakeeb, A;Pitt, HA;Cameron, JL
目的介绍一种简便的胆管癌分类方法，并应用该系统对单个机构的大量患者进行分析。在过去的20年里，大多数西方关于胆管癌的报道将肝内肿瘤与肝外肿瘤分开，并将后者亚组分为近端、中端和远端亚组。然而，“中间”病变并不常见，通常通过肝门切除术或胰十二指肠切除术来治疗。因此，胆管癌的频谱最好分为三大类：1)肝内肿瘤，2)肝门周围肿瘤和3)远端肿瘤。这些分类与解剖分布相关，并暗示首选治疗方法。方法回顾性分析约翰霍普金斯医院23年来所有经组织学证实的胆管癌手术探查患者的资料。结果294例胆管癌患者中，肝内18例（6%），肝门周围196例（67%），远端80例（2746）。三组患者的年龄、性别、种族和相关疾病相似。根据定义，肝内肿瘤患者出现黄疸的可能性较小（p < 0.01），出现腹痛的可能性较大（p < 0.05）。切除率随远端位置的增加而增加（50% vs. 56% vs. 91%），切除可提高每个部位的生存率。切除肝内、门周和远端肿瘤的5年生存率分别为44%、11%和28%，中位生存率分别为26、19和22个月。术后放疗没有提高生存率。在多因素分析中，切除（p < 0.001，风险比2.80）、阴性显微切缘（p < 0.01，风险比1.79）、术前血清白蛋白（p < 0.04，风险比0.82）和术后脓毒症（p < 0.001，风险比0.27）是预后的最佳预测因子。结论血管癌可分为三大类。切除仍然是主要的治疗方法，而术后辅助放疗对生存没有影响。因此，需要新的药物或策略来提供辅助治疗以提高生存率。
ObjectiveThe objective of this article is to introduce a simple method for classifying cholangiocarcinomas and to apply this system to analyze a large number of patients from a single institution.Summary Background DataFor the past 2 decades, most western reports on cholangiocarcinoma have separated intrahepatic from extrahepatic tumors and have subclassified this latter group into proximal, middle, and distal subgroups. However, ''middle'' lesions are uncommon and are managed most often either with hilar resection or with pancreatoduodenectomy. The spectrum of cholangiocarcinoma, therefore, is best classified into three broad groups: 1) intrahepatic, 2) perihilar, and 3) distal tumors. These categories correlate with anatomic distribution and imply preferred treatment.MethodsThe records of all patients with histologically confirmed cholangiocarcinoma who underwent surgical exploration at The Johns Hopkins Hospital over a 23-year period were reviewed.ResultsOf 294 patients with cholangiocarcinoma, 18 (6%) had intrahepatic, 196 (67%) had perihilar, and 80 (2746) had distal tumors. Age, gender, race, and associated diseases were similar among the three groups. Patients with intrahepatic tumors, by definition, were less likely (p < 0.01)to be jaundiced and more likely (p < 0.05) to present with abdominal pain. The resectability rate increased with a more distal location (50% vs. 56% vs. 91%), and resection improved survival at each site. Five-year survival rates for resected intrahepatic, perihilar, and distal tumors were 44%, 11%, and 28%, and median survival rates were 26, 19, and 22 months, respectively. Postoperative radiation therapy did not improve survival. In a multivariate analysis resection (p < 0.001, hazard ratio 2.80), negative microscopic margins (p < 0.01, hazard ratio 1.79), preoperative serum albumin (p < 0.04, hazard ratio 0.82), and postoperative sepsis (p < 0.001, hazard ratio 0.27) were the best predictors of outcome.ConclusionsCholangiocarcinoma is best classified into three broad categories. Resection remains the primary treatment, whereas postoperative adjuvant radiation has no influence on survival. Therefore, new agents or strategies to deliver adjuvant therapy are needed to improve survival.