Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma
Staging, resectability, and outcome in 225 patients with hilar cholangiocarcinoma
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DOI：
10.1097/00000658-200110000-00010
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发表时间：
2001-10-01
影响因子：
9
通讯作者：
Blumgart, LH
中科院分区：
文献类型：
--
作者：
Jarnagin, WR;Fong, Y;Blumgart, LH
目的分析肝门部胆管癌术前分期方案的可切除性和生存率。摘要背景资料肝门部胆管癌患者的长期生存取决于肿瘤完全切除。目前的分期系统忽略了与局部肿瘤范围相关的因素，妨碍了准确的术前疾病评估，与可切除性和生存率的相关性较差。方法前瞻性地分析连续病例的人口统计学、影像研究结果、手术结果、病理和生存率。根据肿瘤累及导管的程度、有无门静脉受累和有无肝叶萎缩，将所有患者分为三个阶段。结果从1991年3月到2000年12月，225例患者接受了评估，其中77%的患者是在最近6年内就诊和治疗。65例患者有不能切除的疾病；160例患者接受了有治疗意图的探查。80例患者接受了切除：62例(78%)同时行肝切除，62例(78%)行RO切除(组织学切缘阴性)。组织学切缘阴性、合并肝部分切除和分化良好的肿瘤组织学与所有切除后预后改善相关。然而，在接受RO切除的患者中，伴随的肝部分切除是长期生存的唯一独立预测因素。在9名实际的5年幸存者(30名高危患者)中，所有人都同时接受了肝切除，没有一人有肿瘤侵犯的边缘；这9名患者中有3人在中位数88个月的随访期内仍然没有疾病。术后并发症和死亡率分别为%和10%。在219例疾病可以分期的患者中，该系统预测了可切除性和RO切除的可能性，并与转移疾病和生存率相关。结论通过充分考虑局部肿瘤的范围，建议的肝门部胆管癌分期系统可以准确地预测可切除性、转移疾病的可能性和生存期。完全切除仍然是提供长期生存可能性的唯一治疗方法，而肝切除是外科手术的关键组成部分。
ObjectiveTo analyze resectability and survival in patients with hilar cholangiocarcinoma according to a proposed preoperative staging scheme that fully integrates local, tumor-related factors.Summary Background DataIn patients with hilar cholangiocarcinoma, long-term survival depends critically on complete tumor resection. The current staging systems ignore factors related to local tumor extent, preclude accurate preoperative disease assessment, and correlate poorly with resectability and survival.MethodsDemographics, results of imaging studies, surgical findings, pathology, and survival were analyzed prospectively in consecutive patients. Using data from imaging studies, all patients were placed into one of three stages based on the extent of ductal involvement by tumor, the presence or absence of portal vein compromise, and the presence or absence of hepatic lobar atrophy.ResultsFrom March 1991 through December 2000, 225 patients were evaluated, 77% of whom were seen and treated within the last 6 years. Sixty-five patients had unresectable disease; 160 patients underwent exploration with curative intent. Eighty patients underwent resection: 62 (78%) had a concomitant hepatic resection and 62 (78%) had an RO resection (negative histologic margins). Negative histologic margins, concomitant partial hepatectomy, and well-differentiated tumor histology were associated with improved outcome after all resections. However, in patients who underwent an RO resection, concomitant partial hepatectomy was the only independent predictor of long-term survival. Of the 9 actual 5-year survivors (of 30 at risk), all had a concomitant hepatic resection and none had tumor-involved margins; 3 of these 9 patients remained free of disease at a median follow-up of 88 months. The rates of complications and death after resection were 64% and 10%, respectively. In the 219 patients whose disease could be staged, the proposed system predicted resectability and the likelihood of an RO resection and correlated with metastatic disease and survival.ConclusionBy taking full account of local tumor extent, the proposed staging system for hilar cholangiocarcinoma accurately predicts resectability, the likelihood of metastatic disease, and survival. Complete resection remains the only therapy that offers the possibility of long-term survival, and hepatic resection is a critical component of the surgical approach.