Intrahepatic Cholangiocarcinoma: Prognosis of Patients Who Did Not Undergo Lymphadenectomy
Intrahepatic Cholangiocarcinoma: Prognosis of Patients Who Did Not Undergo Lymphadenectomy
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DOI：
10.1016/j.jamcollsurg.2015.09.012
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发表时间：
2015-12-01
影响因子：
5.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
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作者：
Bagante, Fabio;Gani, Faiz;Pawlik, Timothy M.
背景：常规淋巴清扫术(LD)在肝内胆管癌(ICC)手术患者中的作用仍不明确。本研究旨在评估常规LD的作用，以及量化不评估结节站对ICC肝脏手术患者疾病特异性生存(DSS)的影响。STUDY设计：使用来自12个主要肝胆中心的数据，在1990-2012年间确定了561例接受ICC肝脏手术的患者。结果：272例(48.5%)接受根治术的患者中，123例(45.2%)有淋巴结转移(N1)。在存活至18个月的患者中，N0和NX患者术后18个月的DSS差异有统计学意义(N0和NX分别为70.2%和60.6%，P=0.019)，但NX患者60个月的DSS与N0患者相似(P=0.48)。相反，尽管N1和NX患者的DSS在短期内具有可比性(18个月的DSS：P=0.13)，但在存活到18个月的患者中，N1患者的DSS低于NX患者(在存活到18个月的患者中，60个月的DSS：N1对NX，分别为15.2%和45.8%，p<；0.001；所有p值均基于两条生存曲线的对数等级检验。结论：虽然NX患者和N1患者在短期内有相似的DSS，但存活超过18个月的NX患者的生存时间与N0患者相似。缺乏结节分期可能导致ICC患者的不同和潜在的错误预后分类。(C)2015年由美国外科医师学会颁发。由Elsevier Inc.出版。保留所有权利
BACKGROUND: The role of routine lymphadenectomy (LD) among patients undergoing surgery for intrahepatic cholangiocarcinoma (ICC) remains poorly defined. This study aimed to evaluate the role of routine LD as well as to quantify the impact of not assessing nodal station on disease-specific survival (DSS) among patients undergoing liver surgery for ICC.STUDY DESIGN: Using data from 12 major hepatobiliary centers, 561 patients undergoing liver surgery for ICC between 1990 and 2012 were identified. The association between nodal status and DSS was assessed using Cox proportional and Aalen's linear hazards models.RESULTS: Among the 272 (48.5%) patients who underwent LD, 123 (45.2%) had lymph node metastasis (N1). Although differences in DSS were noted between N0 and Nx patients within the first 18 months after surgery (DSS at 18 months: N0 vs Nx, 70.2% vs 60.6%, respectively, p = 0.019) among patients who had survived to 18 months, the DSS at 60 months of Nx patients was comparable to that of N0 patients (p = 0.48). Conversely, although the DSS of N1 and Nx patients was comparable in the short-term (DSS at 18 months: p = 0.13), among patients who had survived to 18 months, N1 patients had a lower DSS compared with Nx patients (DSS at 60 months among patients who had survived to 18 months: N1 vs Nx, 15.2% vs 45.8%, respectively, p < 0.001; all p values were based on the log-rank test comparing 2 survival curves).CONCLUSIONS: Although Nx patients and N1 patients had comparable DSS in the short-term, Nx patients who survived past 18 months had a survival comparable to that of N0 patients. Lack of nodal staging may lead to heterogeneous and potentially incorrect prognostic classification of patients with ICC. (C) 2015 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved