Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma - Implications for adjuvant therapeutic strategies
Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma - Implications for adjuvant therapeutic strategies
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DOI：
10.1002/cncr.11699
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发表时间：
2003-10-15
期刊：
影响因子：
6.2
通讯作者：
Fong, YM
中科院分区：
文献类型：
--
作者：
Jarnagin, WR;Ruo, L;Fong, YM
背景资料。目前对胆囊癌(GBCA)和肝门部胆管癌(HCCA)切除后辅助治疗的方法是基于对这些疾病复发模式的不完全理解。通过对GBCA和HCCA切除后最初复发部位的深入分析，本研究旨在强调这些肿瘤的生物学差异，并为辅助治疗策略提供进一步的洞察力。方法：从维护的数据库中前瞻性地识别接受潜在根治性切除的GBCA或HCCA患者。对最初复发的特定部位进行了回顾性分析，并将其归类为局部区域(切除边缘、肝门或腹膜后淋巴结)或远处(腹膜、腹外或不连续的肝转移)。结果：在1990年5月至2001年8月期间，177例患者接受了潜在的根治性切除，97例接受了GBCA，80例接受了HCCA。156名患者的疾病复发和随访数据可用(GBCA组80例，HCCA组76例)。与肝细胞癌相比，肝细胞癌患者的中位复发时间更短(11.5月比20.3个月；P=0.007)。总体而言，52名(68%)HCCA患者和53名(66%)GBCA患者在平均24个月的随访期内出现了疾病复发。在发生疾病复发的患者中，15%的基底动脉狭窄患者以局部局部疾病为首发失败部位，而肝细胞癌患者的这一比例为59%(P<；0.001)。相比之下，85%的患者最初复发的部位位于远处，伴有或不伴有局部复发，而肝细胞癌患者的这一比例为41%(P<；0.001)。这种疾病复发的模式是诊断特有的，当患者根据几个临床病理因素分层时，包括疾病分期及其组成变量时，这种模式没有显著变化。使用多变量分析，诊断是疾病复发部位的独立预测因素。在疾病复发的患者中，肝细胞癌患者的生存期(29个月)高于肝细胞癌患者(20.6个月；P=0.037)。对于这两种肿瘤，初次复发的部位对生存时间没有明显的影响。结论：切除后复发的GBCA比复发的HCCA更有可能累及远处。GBCA还与较短的复发时间和较短的复发后生存期有关。结果表明，这些肿瘤的临床行为有显著差异，并表明针对局部疾病的辅助治疗策略，如放射治疗，不太可能对GBCA的整体管理产生重大影响。相反，根据初次复发的模式，至少在HCCA患者中采用这种方法是有一定道理的。(C)2003年美国癌症协会。
BACKGROUND. Current approaches to adjuvant treatment after resection of gallbladder carcinoma (GBCA) and hilar cholangiocarcinoma (HCCA) are based on an incomplete understanding of the recurrence patterns of these diseases. Through an in-depth analysis of the sites of initial recurrence after resection of GBCA and HCCA, the current study aimed to highlight differences in the biology of these tumors and to provide further insight for adjuvant therapeutic strategies.METHODS. Patients with either GBCA or HCCA who underwent a potentially curative resection were identified prospectively from a maintained database. Specific sites of initial disease recurrence were identified retrospectively and categorized as locoregional (resection margin, porta hepatis, or retroperitoneal lymph nodes) or distant (peritoneal, extraabdominal, or discontiguous liver metastases). Differences in disease recurrence patterns, time to disease recurrence, and overall and site-specific survival were analyzed.RESULTS. Between May 1990 and August 2001, 177 patients underwent potentially curative resection, 97 for GBCA and 80 for HCCA. Disease recurrence and follow-up data were available for 156 patients (80 with GBCA and 76 with HCCA). The median time to disease recurrence was shorter for patients with GBCA compared with patients with HCCA (11.5 vs. 20.3 months; P = 0.007). Overall, 52 (68%) patients with HCCA and 53 (66%) patients with GBCA had disease recurrene at a median follow-up of 24 months. Of those who developed disease recurrence, isolated locoregional disease as the first site of failure occurred in 15% of patients with GBCA compared with 59% of patients with HCCA (P < 0.001). By contrast, an initial GBCA recurrence involving a distant site, with or without concomitant locoregional recurrence, occurred in 85% of patients compared with 41% of patients with HCCA (P < 0.001). This pattern of disease recurrence was diagnosis specific and did not change significantly when patients were stratified by several clinicopathologic factors, including disease stage and its component variables. Using multivariate analysis, diagnosis was an independent predictor of the site of disease recurrence. Among patients who experienced disease recurrence, survival was greater among the patients with HCCA compared with patients with GBCA (29 months vs. 20.6 months, respectively; P = 0.037). For both tumors, the site of initial disease recurrence had no apparent impact on survival time.CONCLUSIONS. After resection, recurrent GBCA is much more likely than recurrent HCCA to involve a distant site. GBCA is also associated with a much shorter time to recurrence and a shorter survival period after recurrence. The results demonstrated significant differences in the clinical behavior of these tumors and suggested that an adjuvant therapeutic strategy targeting locoregional disease, such as radiotherapy, is unlikely to have a significant impact in the overall management of GBCA. Conversely, there is at least some rationale for such an approach in patients with HCCA based on the pattern of initial recurrence. (c) 2003 American Cancer Society.