Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation
Treatment of hilar cholangiocarcinoma (Klatskin tumors) with hepatic resection or transplantation
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DOI：
10.1016/s1072-7515(98)00207-5
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发表时间：
1998-10-01
影响因子：
5.2
通讯作者：
Starzl, TE
中科院分区：
文献类型：
--
作者：
Iwatsuki, S;Todo, S;Starzl, TE
背景：由于肝门部胆管癌的罕见性，其预后危险因素尚未得到充分分析。本回顾性研究进行了评估各种病理危险因素，影响生存后根治性肝切除术或transplant.Methods：在1981年和1996年，72例（43名男性和29名女性）与肝门部胆管癌进行了肝切除术（34例）或移植（38例）与根治性intention。回顾病历和病理标本，以检查各种预后风险因素。通过Kaplan-Meier方法，使用对数秩检验计算生存率，并根据手术类型进行调整。分别计算每种治疗方法的生存率，然后合并计算最终的显著性value.Results：肝切除术后1，3，5年的生存率分别为74%，34%和9%，移植后分别为60%，32%和25%。单因素分析显示，T-3、淋巴结阳性、手术切缘阳性、pTNM III期和TV是有统计学意义的不良预后因素。多因素分析显示，pTNM分期0、I、II、淋巴结阴性、手术切缘阴性是影响预后的重要因素，其中pTNM分期0~II、手术切缘阴性患者的1、3、5年生存率分别为80%、73%、73%。对于pTNM分期IV-A且淋巴结和手术切缘阴性的患者，1年、3年和5年生存率分别为66%、37%和37%.Conclusions：肝门部胆管癌无论是肝切除还是肝移植，均能获得满意的长期生存率。建议重新定义pTNM III期和TV-A，以更好地定义预后。（J Am Cell Surg 1998; 187：358 - 364. (C)1998年由美国外科医生学会出版）。
Background: Because of the rarity of hilar cholangiocarcinoma, its prognostic risk factors have not been sufficiently analyzed. This retrospective study was undertaken to evaluate various pathologic risk factors which influenced survival after curative hepatic resection or transplantation.Methods: Between 1981 and 1996, 72 patients (43 males and 29 females) with hilar cholangiocarcinoma underwent hepatic resection (34 patients) or transplantation (38 patients) with curative intent. Medical records and pathologic specimens were reviewed to examine the various prognostic risk factors. Survival was calculated by the method of Kaplan-Meier using the log rank test with adjustment for the type of operation. Survival statistics were calculated first for each kind of treatment separately, and then combined for the calculation of the final significance value.Results: Survival rates for 1, 3, and 5 years after hepatic resection were 74%, 34%, and 9%, respectively, and those after transplantation were 60%, 32%, and 25%, respectively. Univariate analysis revealed that T-3, positive lymph nodes, positive surgical margins, and pTNM stage III and TV were statistically significant poor prognostic factors. Multivariate analysis revealed that pTNM stage 0, I, and II, negative lymph node, and negative surgical margins were statistically significant good prognostic factors.For the patients in pTNM stage 0-II with negative surgical margins, 1-, 3-, and 5-year survivals were 80%, 73%, and 73%, respectively. For patients in pTNM stage IV-A with negative lymph nodes and surgical margins, 1-, 3-, and 5-year survivals were 66%, 37%, and 37%, respectively.Conclusions: Satisfactory longterm survivals can be obtained by curative surgery for hilar cholangiocarcinoma either with hepatic resection or liver transplantation. Redefining pTNM stage III and TV-A is proposed to better define prognosis. (J Am Cell Surg 1998;187: 358-364. (C) 1998 by the American College of Surgeons).