Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma
Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma
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DOI：
10.1002/cncr.20906
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发表时间：
2005-03-15
期刊：
影响因子：
6.2
通讯作者：
Hatakeyama, K
中科院分区：
文献类型：
--
作者：
Wakai, T;Shirai, Y;Hatakeyama, K
背景。本研究的目的是澄清在接受肝外胆管癌手术切除的患者中，导管切除边缘残留原位癌是否与残留浸润性导管病变的预后不同。方法。对84例接受手术切除的肝外胆管癌患者进行回顾性分析。导管切除边缘状态分为阴性（n = 64 名患者）、原位癌阳性（n = 11 名患者）或浸润性癌阳性（n = 9 名患者）。中位随访期为 105 个月。结果。单变量（P = 0.0002）和多变量（P = 0.0039）分析发现导管边缘状态是一个强有力的独立预后因素。导管边缘阴性的患者（中位生存时间为 45 个月；累积 10 年生存率为 40%）和导管边缘阳性的原位癌患者（中位生存时间为 99 个月；累积 10 年生存率为 23%；P = 0.4742）的手术切除结果具有可比性。在导管切缘阳性的患者中，残留原位癌患者的预后明显优于残留浸润性癌患者（中位生存时间为 21 个月；累积 5 年生存率为 0%；P = 0.0003）。在11例原位残留癌患者中，4例死于肿瘤复发，且疾病复发的起始部位为局部。 M 9例残留浸润癌患者在手术切除后40个月内死于疾病复发（局部复发伴或不伴远处转移）。结论。肝外胆管癌手术切除后，导管切除边缘的浸润性癌似乎对患者的生存产生强烈的不利影响，而残留的原位癌则不会。癌症 2005；103：1210-6。 (C) 2005 年美国癌症协会。
BACKGROUND. The current study was performed to clarify whether the presence of residual carcinoma in situ at ductal resection margins differs prognostically from residual invasive ductal lesions in patients undergoing surgical resection for extrahepatic cholangiocarcinorna. METHODS. A retrospective analysis of 84 patients with extrahepatic cholangiocarcinoma who under-went surgical resection was conducted. The ductal resection margin status was classified as negative (n = 64 patients), positive with carcinoma in situ (n = 11 patients), or positive with invasive carcinoma (n = 9 patients). rhe median follow-up period was 105 months. RESULTS. Ductal margin status was found to be a strong independent prognostic factor by both univariate (P = 0.0002) and multivariate (P = 0.0039) analyses. The outcome after surgical resection was comparable between patients with negative ductal margins (median survival time of 45 months; cumulative 10-year survival rate of 40%) and those with positive ductal margins with carcinoma in situ (median survival time of 99 months; cumulative 10-year survival rate of 23%; P = 0.4742). In patients with positive ductal margins, the outcome was found to be significantly better in patients with residual carcinoma in situ than in those with residual invasive carcinoma (median survival time of 21 months; cumulative 5-year survival rate of 0%; P = 0.0003). Of I I patients with residual carcinoma in situ, 4 died of tumor recurrence and the initial site of the disease recurrence was local. M 9 patients with residual invasive carcinoma died of disease recurrence (local recurrence with or without distant metastases) within 40 months after surgical resection. CONCLUSIONS. After surgical resection for extrahepatic cholangiocarcinorna, invasive carcinoma at ductal resection margins appears to have a strong adverse effect on patient survival, whereas residual carcinoma in situ does not. Cancer 2005;103: 1210-6. (C) 2005 American Cancer Society.