Prognostic Impact of Tumor Growth Type on 7th AJCC Staging System for Intrahepatic Cholangiocarcinoma: a Single-Center Experience of 659 Cases
Prognostic Impact of Tumor Growth Type on 7th AJCC Staging System for Intrahepatic Cholangiocarcinoma: a Single-Center Experience of 659 Cases
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DOI：
10.1007/s11605-015-2803-6
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发表时间：
2015-07-01
影响因子：
3.2
通讯作者：
Lee, Sung-Gyu
中科院分区：
文献类型：
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作者：
Hwang, Shin;Lee, Young-Joo;Lee, Sung-Gyu
由于第七届美国癌症联合委员会（AJCC）肝内胆管癌（IHCC）的肿瘤淋巴结转移（TNM）分期发生了显著变化，我们验证了肉眼根治性切除IHCC后肿瘤分期对预后的影响，选择了659例行R 0（n = 539）或R1（n = 120）切除的IHCC患者，排除R2切除（n = 111）。研究患者接受了每千日元24个月的随访或直至死亡，生存分析期间没有患者死亡。599例（90.9%）进行了解剖切除，97例（14.7%）进行了同期胆管切除。R 0、R1和R2切除术后的中位生存期分别为28、12和3个月（p = 0.000）。在R 0切除组中，1、3、5和10年肿瘤复发率分别为36.4%、57.9%、64.7%和65.0%，1、3、5和10年患者生存率分别为73.1%、44.2%、33.0%和23.1%。肿瘤复发和患者生存的独立危险因素是肿瘤生长类型、肿瘤大小> 5cm、神经周围浸润和淋巴结转移。按AJCC第7期分期，T2-4期无淋巴结转移者预后差（p > 0.8）。我们重新定义了肿瘤生长类型和危险因素（包括肿瘤数量和周围神经/淋巴血管浸润）的分期系统，在T1-3期之间获得了明确的预后对比（p = 0.000）。IHCC的生长类型似乎是确定肿瘤分期的关键。虽然第7届AJCC IHCC分期系统的分层似乎合理建立，细化和进一步验证可以提高预后的预测性。
Because noticeable changes were made to the 7th American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging for intrahepatic cholangiocarcinoma (IHCC), we validated the prognostic impact of tumor staging after macroscopic curative resection of IHCC.A cohort of 659 IHCC patients who underwent R0 (n = 539) or R1 (n = 120) resection were selected with exclusion of R2 resection (n = 111). Study patients were followed up for a parts per thousand yen24 months or until death with no patient lost during survival analysis.Anatomical resection was performed in 599 (90.9 %) and concurrent bile duct resection was conducted in 97 (14.7 %). Median survival periods following R0, R1, and R2 resections were 28, 12, and 3 months, respectively (p = 0.000). In the R0 resection group, the 1-, 3-, 5-, and 10-year tumor recurrence rates were 36.4 %, 57.9 %, 64.7 %, and 65.0 %, respectively, and the 1-, 3-, 5-, and 10-year patient survival rates were 73.1 %, 44.2 %, 33.0 %, and 23.1 %, respectively. Independent risk factors for tumor recurrence and patient survival were tumor growth type, tumor size > 5 cm, perineural invasion, and lymph node metastasis. According to the 7th AJCC staging system, the prognostic contrast was marginal in stage T2-4 tumors without lymph node metastasis (p > 0.8). With our redefined staging system with tumor growth types and risk factors including tumor number and perineural/lymphovascular invasion, clear prognostic contrast was achieved among T1-3 stages (p = 0.000).Growth type of IHCC seems to be essential for determining tumor stage. Although the stratification of the 7th AJCC IHCC staging system seems reasonably established, refinements and further validation could improve prognostic predictability.