Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma
Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma
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DOI：
10.1002/jso.20668
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发表时间：
2007-03-01
影响因子：
2.5
通讯作者：
Sueda, Taijiro
中科院分区：
文献类型：
--
作者：
Murakami, Yoshiaki;Uemura, Kenichiro;Sueda, Taijiro
背景和目的：远端胆管癌患者的预后指标由于其罕见而尚未得到证实。本研究的目的是确定接受远端胆管癌手术切除的患者的有用预后因素。方法：对 43 例接受手术切除的远端胆管癌患者的病历进行回顾性分析。 35 例患者行胰十二指肠切除术，8 例行段性胆管切除术。通过单因素和多因素生存分析检查潜在的临床病理预后因素。结果：19 例患者（44%）术后出现术后并发症，但无死亡。 1 年、3 年和 5 年总生存率分别为 72%、53% 和 44%（中位生存时间为 26.0 个月）。单变量分析发现，年龄较大、病理性胰腺侵犯、淋巴结转移、神经周围侵犯、手术切缘阳性、TNM 11 期和 III 期是预后不良的显着预测因素（P < 0.05）。此外，Cox比例风险回归模型发现淋巴结转移和阳性手术切缘是不良预后的显着独立预测因子（P < 0.05）。结论：这些结果表明，通过手术切除确定的淋巴结转移和阳性手术切缘可能有助于预测远端胆管癌患者的术后结果。
Background and Objectives: Prognostic indicators for patients with distal cholangiocarcinoma have not been confirmed because of its rarity. The aim of this study was to identify useful prognostic factors in patients undergoing surgical resection for distal cholangiocarcinoma.Methods: Charts of 43 patients with distal cholangiocarcinoma who underwent surgical resection were retrospectively reviewed. Pancreatoduodenectomy was performed in 35 patients, and segmental bile duct resection in 8. Potential clinicopathological prognostic factors were examined by univariate and multivariate survival analysis.Results: Postoperative complications occurred after surgery in 19 patients (44%), but there was no mortality. Overall survival rates were 72%, 53%, and 44% for 1, 3, and 5 years, respectively (median survival time, 26.0 months). Univariate analysis found that older age, pathological pancreatic invasion, lymph node metastasis, perineural invasion, positive surgical margin, and TNM stages 11 and III were significant predictors of poor prognosis (P < 0.05). Furthermore, lymph node metastasis and positive surgical margin were found to be significant independent predictors of poor prognosis with a Cox proportional hazards regression model (P < 0.05).Conclusions: These results suggest that lymph node metastasis and positive surgical margin as determined by surgical resection might be useful in predicting post-surgical outcome in patients with distal cholangiocarcinoma.