The Prognosis and Survival Outcome of Intrahepatic Cholangiocarcinoma Following Surgical Resection: Association of Lymph Node Metastasis and Lymph Node Dissection with Survival
The Prognosis and Survival Outcome of Intrahepatic Cholangiocarcinoma Following Surgical Resection: Association of Lymph Node Metastasis and Lymph Node Dissection with Survival
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DOI：
10.1245/s10434-009-0631-1
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发表时间：
2009-11-01
影响因子：
3.7
通讯作者：
Chung, Jae-Bock
中科院分区：
文献类型：
--
作者：
Choi, Sae-Byeol;Kim, Kyung-Sik;Chung, Jae-Bock
手术切除已被证明可以提高肝内胆管癌（ICC）患者的长期生存率。淋巴结清扫术的益处仍有争议。为探讨ICC的预后因素，以及淋巴结转移和淋巴结清扫程度对生存率的影响，对64例ICC患者进行了根治性手术，并进行了大体根治性切除（R0和R1）。根据淋巴结清扫的范围对患者进行分类。回顾性分析所有病例的临床病理特征和生存情况，所有病例均行解剖性切除。5年生存率为39.5%。多因素分析显示，淋巴结转移（危险比：3.317）是影响生存的独立预后因素。41例患者复发。中位无病生存期为12.3个月。肿瘤分化程度是无病生存的独立预后因素（风险比：3.158）。淋巴结清扫范围对并发症的发生无明显影响。区域+ α淋巴结清扫组的生存率与淋巴结采样组相似，但在区域+ α淋巴结清扫组中观察到淋巴结转移的发生率显著较高。无淋巴结转移的ICC患者，淋巴结清扫范围对生存率无明显影响，区域+ α淋巴结清扫可提高有淋巴结转移的ICC患者的生存率，而准确的淋巴结状况可通过胆总管周围淋巴结清扫得到证实。
Surgical resection has been shown to improve long-term survival for patients with intrahepatic cholangiocarcinoma (ICC). The benefit of lymph node dissection is still controversial. The aims of this study were to investigate the prognostic factors of ICC and to examine the impact of lymph node metastasis and extent of lymph node dissection on survival.A total of 64 patients with ICC were operated on with curative intent and resultant macroscopic curative resection (R0 and R1). The patients were classified according to the extent of the lymph node dissection. Clinicopathological characteristics and survival were reviewed retrospectively.All patients underwent anatomical resection. The 5-year survival rates were 39.5%. Multivariate analysis revealed that lymph node metastasis (hazard ratio: 3.317) was an independent prognostic factors on survival. Recurrence occurred in 41 patients. Median disease-free survival time was 12.3 months. Tumor differentiation was an independent prognostic factor for disease-free survival (hazard ratio: 3.158). The extent of lymph node dissection did not affect the occurrence of complication. Regional + alpha lymph node dissection group demonstrated similar survival to those of lymph node sampling group, although significant high incidence of lymph node metastases was observed in the regional + alpha lymph node dissection group. The extent of lymph node dissection did not affect the survival in the patients without lymph node involvement.The regional + alpha lymph node dissection enhanced the survival in the ICC patients with lymph node metastasis, and the exact nodal status could be confirmed by lymph node dissection in the pericholedochal lymph nodes.