Radical resection of hilar bile duct carcinoma and predictors of survival
Radical resection of hilar bile duct carcinoma and predictors of survival
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DOI：
10.1046/j.1365-2168.2000.01343.x
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发表时间：
2000-03-01
影响因子：
9.6
通讯作者：
Fukao, K
中科院分区：
文献类型：
--
作者：
Todoroki, T;Kawamoto, T;Fukao, K
背景：主肝管癌患者预后较差。本研究试图找出手术后生存的临床病理预测因素。方法：对1976至1998年间114例表现为肝导管癌的患者进行了回顾分析。114例患者中，98例行根治性切除，3例行姑息性切除，13例行非手术治疗。46例TVA期患者手术切除后均有微小肿瘤残留。其中28例接受放射治疗，18例单纯手术切除。结果：总的手术并发症和死亡率分别为14%和4%。手术切除后总的5年生存率为28%。19例LBR存活超过5年，其中10例为IVA期。影响预后的主要因素有：表现状态、黄疸、肿瘤部位、大体形态、组织学分级、肿瘤转移(TNM)T、N、M分类、TNM分期和残存肿瘤。多因素COX分析显示，辅助放疗、肿瘤向肝管内扩散、组织学分级、N和残存肿瘤是影响肝门部胆管癌术后生存的独立因素。结论：根治性切除是肝门部胆管癌患者难得的最佳生存方式。对于IVA期患者，完全大体切除后放射治疗改善了治疗结果。
Background: Patients with carcinoma of the main hepatic duct have a poor prognosis. This study attempted to identify clinicopathological predictors of survival after resection.Methods: A retrospective review was performed of 114 patients who presented with hepatic ductal carcinoma between 1976 and 1998. Of the 114 patients, 98 had a radical resection, three underwent palliative resection and 13 were not treated surgically. Forty-six patients with stage TVA disease had microscopic tumour residue after resection. Of these, 28 patients were treated with radiotherapy and the remaining 18 had resection alone.Results: The overall operative morbidity and mortality rates were 14 and 4 per cent respectively. The overall 5-year survival rate after resection was 28 per cent. Nineteen patients survived lbr more than 5 years, including ten with stage IVA disease. The main prognostic factors were performance status; jaundice; tumour location; gross appearance; histological grade; T, N and M categories in tumour node metastasis (TNM) classification; TNM stage; and residual tumour. Adjuvant radiotherapy, tumour extension into the hepatic ducts, histological grade, N and residual tumour were independent predictive factors by multivariate Cox analysis.Conclusion: This study suggests that radical resection provides the best survival rare for patients with hilar bile duct carcinoma. For patients with stage IVA disease, following complete gross resection radiotherapy improved treatment outcome.