Outcomes after curative resections of cholangiocarcinoma.
Outcomes after curative resections of cholangiocarcinoma.
复制标题
胆管癌根治性切除术后的结果。
作者：
D. Nagorney;J. Donohue;M. Farnell;Cathy D. Schleck;D. M. Ilstrup
目标
阐明肝外胆管癌的临床和病理特征，并确定手术治疗患者的预后变量。
设计
回顾性分析接受胆管癌手术探查患者的临床记录，对影响患者生存的临床和病理因素进行单变量和多变量分析。
设置
明尼苏达州罗切斯特的马约诊所。
研究参与者
1976年至1985年间，因诊断、姑息或治愈原因接受手术干预的171例患者。完成随访直至死亡或存活患者至少5年。
干预
29%的患者进行了根治性手术切除，其余患者进行了肿瘤活检或姑息性手术。
主要观察指标
手术治疗后的患者生存率。
结果
该患者队列的手术死亡率为5%，中位生存期为13个月。总的5年生存率为16%，44%的患者在5年时仍然存活。采用单因素分析，根治性切除，肿瘤分期，东部肿瘤协作组的性能状态，总胆红素浓度，淋巴结状态，肝浸润，肿瘤形态，肿瘤分级和肿瘤起源部位是预后的重要决定因素。采用考克斯比例风险模型进行多变量分析，根治性切除、东部肿瘤协作组体力状态、总胆红素浓度和肿瘤分级是预测患者结局的唯一变量。近端胆管癌根治性切除术与远端胆管癌根治性切除术的长期生存率相似。
结论
虽然肿瘤的范围和患者的整体健康状况会影响结果，但应在所有部位进行胆管癌的根治性切除，因为这种治疗提供了长期生存的最佳机会。
OBJECTIVES
To elucidate the clinical and pathologic features of extrahepatic cholangiocarcinomas and to identify prognostic variables in patients treated surgically.
DESIGN
Retrospective review of clinical records of patients undergoing surgical exploration for cholangiocarcinoma, with univariate and multivariate analyses of the clinical and pathologic factors that influenced patient survival.
SETTING
Mayo Clinic, Rochester, Minn.
STUDY PARTICIPANTS
One hundred seventy-one patients undergoing operative intervention for diagnostic, palliative, or curative reasons between 1976 and 1985. Follow-up was complete until death or for a minimum of 5 years for surviving patients.
INTERVENTION
A curative surgical resection was performed in 29% of patients, while the remainder underwent tumor biopsy or a palliative procedure.
MAIN OUTCOME MEASURE
Patient survival following operative treatment.
RESULTS
The operative mortality in this patient cohort was 5% and median survival was 13 months. Overall 5-year survival was 16%, with 44% of patients having a curative resection still alive at 5 years. Using univariate analysis, curative resection, tumor stage, Eastern Cooperative Oncology Group performance status, total bilirubin concentration, lymph node status, liver invasion, tumor morphology, tumor grade, and site of tumor origin were significant determinants of prognosis. Using the Cox proportional hazards model for multivariate analysis, curative resection, Eastern Cooperative Oncology Group performance status, total bilirubin concentration, and tumor grade were the only variables predictive of patient outcome. A curative resection of a proximal cholangiocarcinoma had a similar chance of providing long-term survival as a curative distal ductal resection.
CONCLUSIONS
Although the tumor extent and the patient's overall health will affect outcome, curative resection for cholangiocarcinoma at all sites should be undertaken since this treatment offers the best chance for long-term survival.
DOI：
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发表时间：
1972
期刊：
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影响因子：
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作者：
D. Cox
通讯作者：
D. Cox