Lymphovascular and perineural invasion as selection criteria for adjuvant therapy in intrahepatic cholangiocarcinoma: a multi-institution analysis
Lymphovascular and perineural invasion as selection criteria for adjuvant therapy in intrahepatic cholangiocarcinoma: a multi-institution analysis
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DOI：
10.1111/j.1477-2574.2012.00489.x
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发表时间：
2012-08-01
期刊：
影响因子：
2.9
通讯作者：
Maithel, Shishir K.
中科院分区：
文献类型：
--
作者：
Fisher, Sarah B.;Patel, Sameer H.;Maithel, Shishir K.
目的：肝内胆管细胞癌（IHCC）辅助化疗患者的选择标准缺乏。一些作者主张治疗淋巴结（LN）受累的患者;然而，淋巴结评估通常不充分或不进行。本研究旨在根据原发性肿瘤的特征确定替代标准。方法：2000年1月至2010年1月期间，在三个机构中的任何一个机构共确定了58例IHCC切除术患者。主要结局为总生存期（OS）。结果：中位OS为23.0个月。中位肿瘤大小为6.5 cm，中位病变数量为1个。总的来说，16%的患者有阳性切缘，38%有神经周围浸润（PNI），40%有淋巴血管浸润（LVI），22%有LN受累。中位数为两个LN被删除，中位数为零是阳性的。34%的患者未采集淋巴结样本。血管和神经周围浸润与OS降低相关[分别为9.6个月vs. 32.7个月（P= 0.020）和10.7个月vs. 32.7个月（P= 0.008）]。淋巴结受累表明OS有降低的趋势（10.7个月vs. 30.0个月; P= 0.063）。淋巴结阴性患者中存在LVI或PNI与OS降低相关，与淋巴结阳性患者相似（12.1个月vs. 10.7个月; P= 0.541）。在考虑了不良肿瘤因素后，在多变量分析中，只有LVI和PNI仍与OS降低相关（风险比4.07，95%置信区间1.60 - 10.40; P= 0.003）。结论：与LN阳性患者相似，血管和神经周围浸润分别与OS降低相关。由于淋巴结清扫通常不进行，并且取出的淋巴结数量通常不足，因此应将这些肿瘤特异性因素作为辅助化疗的选择标准。
Objectives: Criteria for the selection of patients for adjuvant chemotherapy in intrahepatic cholangiocarcinoma (IHCC) are lacking. Some authors advocate treating patients with lymph node (LN) involvement; however, nodal assessment is often inadequate or not performed. This study aimed to identify surrogate criteria based on characteristics of the primary tumour. Methods: A total of 58 patients who underwent resection for IHCC between January 2000 and January 2010 at any of three institutions were identified. Primary outcome was overall survival (OS). Results: Median OS was 23.0 months. Median tumour size was 6.5 cm and the median number of lesions was one. Overall, 16% of patients had positive margins, 38% had perineural invasion (PNI), 40% had lymphovascular invasion (LVI) and 22% had LN involvement. A median of two LNs were removed and a median of zero were positive. Lymph nodes were not sampled in 34% of patients. Lymphovascular and perineural invasion were associated with reduced OS [9.6 months vs. 32.7 months (P= 0.020) and 10.7 months vs. 32.7 months (P= 0.008), respectively]. Lymph node involvement indicated a trend towards reduced OS (10.7 months vs. 30.0 months; P= 0.063). The presence of either LVI or PNI in node-negative patients was associated with a reduction in OS similar to that in node-positive patients (12.1 months vs. 10.7 months; P= 0.541). After accounting for adverse tumour factors, only LVI and PNI remained associated with decreased OS on multivariate analysis (hazard ratio 4.07, 95% confidence interval 1.6010.40; P= 0.003). Conclusions: Lymphovascular and perineural invasion are separately associated with a reduction in OS similar to that in patients with LN-positive disease. As nodal dissection is often not performed and the number of nodes retrieved is frequently inadequate, these tumour-specific factors should be considered as criteria for selection for adjuvant chemotherapy.