Prognostic Factors After Surgical Resection for Intrahepatic, Hilar, and Distal Cholangiocarcinoma
Prognostic Factors After Surgical Resection for Intrahepatic, Hilar, and Distal Cholangiocarcinoma
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DOI：
10.1245/s10434-010-1325-4
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发表时间：
2011-03-01
影响因子：
3.7
通讯作者：
Sueda, Taijiro
中科院分区：
文献类型：
--
作者：
Murakami, Yoshiaki;Uemura, Kenichiro;Sueda, Taijiro
胆管癌患者的预后并不令人满意。因此，评估预后因素和建立新的治疗策略，以提高其长期生存。本研究的目的是确定肝内、肝门和远端胆管癌患者的有用预后因素，回顾性分析了127例接受手术切除的胆管癌患者（21例肝内胆管癌，50例肝门胆管癌和56例远端胆管癌）的记录。通过单因素和多因素分析，对127例患者的生存率与临床病理因素（包括患者的人口统计学特征和肿瘤特征）的关系进行了评估，总的1、3和5年生存率分别为80%、51%和40%。单因素分析显示，辅助化疗（P = 0.049）、肿瘤分化程度（P = 0.014）、淋巴结转移（P <0.001）、手术切缘状态（P <0.001）、UICC pT因子（P <0.001）和UICC分期（P <0.001）与生存率显著相关。多变量分析显示，UICC pT因子（P = 0.007）、辅助化疗（P = 0.009）、手术切缘状态（P = 0.012）和淋巴结转移（P = 0.014）仍与长期生存率独立相关。手术切缘阳性和无切缘阳性患者的5年生存率分别为13%和49%。术后辅助化疗与未辅助化疗患者的5年生存率分别为47%和36%，R 0切除术和辅助化疗可能是胆管癌患者获得长期生存的必要措施。
The prognosis of patients with cholangiocarcinoma is unsatisfactory. Therefore, evaluation of prognostic factors and establishment of new therapeutic strategies are needed to improve their long-term survival. The aim of this study was to identify useful prognostic factors for patients with intrahepatic, hilar, and distal cholangiocarcinoma.Records of 127 patients with cholangiocarcinoma (21 with intrahepatic cholangiocarcinoma, 50 with hilar cholangiocarcinoma, and 56 with distal cholangiocarcinoma) who underwent surgical resection were reviewed retrospectively. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate analysis.For all 127 patients, overall 1-, 3-, 5-year survival rates were 80, 51, and 40%, respectively. Univariate analysis revealed that adjuvant chemotherapy (P = .049), tumor differentiation (P = .014), lymph node metastasis (P < .001), surgical margin status (P < .001), UICC pT factor (P < .001), and UICC stage (P < .001) were associated significantly with survival. UICC pT factor (P = .007), adjuvant chemotherapy (P = .009), surgical margin status (P = .012), and lymph node metastasis (P = .014) remained independently associated with long-term survival by multivariate analysis. The 5-year survival rates of patients with or without positive surgical margins were 13 and 49%, respectively. The 5-year survival rates of patients treated with or without adjuvant chemotherapy were 47 and 36%, respectively.R0 resection and adjuvant chemotherapy may be mandatory to achieve long-term survival for patients with cholangiocarcinoma.