An aggressive approach to extrahepatic cholangiocarcinomas is warranted: Margin status does not impact survival after resection
An aggressive approach to extrahepatic cholangiocarcinomas is warranted: Margin status does not impact survival after resection
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DOI：
10.1245/s10434-007-9756-2
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发表时间：
2008-03-01
影响因子：
3.7
通讯作者：
Rosemurgy, Alexander
中科院分区：
文献类型：
--
作者：
Hernandez, Jonathan;Cowgill, Sarah M.;Rosemurgy, Alexander
背景：对于胆管癌，治愈的唯一希望是切除。本研究旨在确定切缘状态、分期、肿瘤位置和辅助治疗对肝外胆管癌切除术后生存的影响。方法：从 1985 年至 2006 年，91 名患者接受了胆管癌切除术。边缘状态被编码为微观/宏观阴性、微观阳性/宏观阴性或微观/宏观阳性。使用 AJCC 分类（第 6 版）确定分期。肿瘤位置分为近端、中部或远端。近端肿瘤通过肝外胆道切除术联合/不联合肝切除术切除（n = 48），远端肝外胆管癌通过胰十二指肠切除术切除（n = 35），中部肿瘤仅通过肝外胆道切除术切除（n = 8）。利用回归分析和生存曲线分析。数据以中位数、平均值+/-标准差(SD)表示。结果：切除后的总生存期为21个月，38+/-46.0。生存率不受边缘状态的影响（R0 20 个月，35 +/- 45.1 对比 R1 32 个月，45 +/- 49.4）。 AJCC 分期与生存率呈负相关（p = 0.004，Spearman 回归分析）。肿瘤位置不影响生存（p = 0.57，对数秩检验）。对于近端肿瘤，胆道切除术后的生存率因是否需要同时进行肝切除术而受到显着影响（15 个月，27 +/- 31.4 对比 41 个月，67 +/- 17.1）。辅助治疗的使用显着提高了生存率（33 个月，56 +/- 63.1 对比 19 个月，33 +/- 40.0）（p = 0.046，Spearman 回归）。结论：肝外胆管癌切除后的生存率受到 AJCC 分期、辅助治疗的使用以及近端肿瘤患者是否需要同时进行肝切除术的显着影响。边缘状态和肿瘤位置不影响生存。无论肿瘤位置如何，胆管癌都应积极切除，即使切除可能导致显微镜下切缘阳性，并应用辅助治疗。
Background: With cholangiocarcinoma, the only hope of a cure is resection. This study was undertaken to determine the impact of margin status, stage, tumor location, and adjuvant therapy on survival after resection of extrahepatic cholangiocarcinoma.Methods: From 1985-2006, 91 patients underwent resections of cholangiocarcinomas. Margin status was codified as micro-/macroscopically negative, microscopically positive/macroscopically negative, or micro-/macroscopically positive. Stage was determined using the AJCC classification (6(th) edition). Tumor location was classified as proximal, mid, or distal. Proximal tumors were resected by extrahepatic biliary resection with/without concomitant hepatic resection (n = 48), distal extrahepatic cholangiocarcinomas by pancreaticoduodenectomy (n = 35), and mid tumors by extrahepatic biliary resection alone (n = 8). Regression analysis and survival curve analysis were utilized. Data are presented as median, mean +/- standard deviation (SD).Results: Overall survival after resection was 21 months, 38 +/- 46.0. Survival was not impacted by margin status (R0 20 months, 35 +/- 45.1 versus R1 32 months, 45 +/- 49.4). AJCC stage inversely correlated with survival (p = 0.004, Spearman regression analysis). Tumor location did not impact upon survival (p = 0.57, log-rank test). For proximal tumors, survival after biliary resection was significantly impacted by the need for concomitant hepatectomy (15 months, 27 +/- 31.4 versus 41 months, 67 +/- 17.1). Utilization of adjuvant therapy significantly improved survival (33 months, 56 +/- 63.1 versus 19 months, 33 +/- 40.0) (p = 0.046, Spearman regression).Conclusions: Survival after resection of extrahepatic cholangiocarcinoma is significantly impacted by AJCC stage, the use of adjuvant therapy, and in patients with proximal tumors, the need for concomitant hepatectomy. Margin status and tumor location do not impact survival. Cholangiocarcinomas should be aggressively resected irrespective of tumor location, even if resection might result in microscopically positive margins, and adjuvant therapy applied.