Intrahepatic Cholangiocarcinoma: An International Multi-Institutional Analysis of Prognostic Factors and Lymph Node Assessment
Intrahepatic Cholangiocarcinoma: An International Multi-Institutional Analysis of Prognostic Factors and Lymph Node Assessment
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DOI：
10.1200/jco.2011.35.6519
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发表时间：
2011-08-10
影响因子：
45.3
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
de Jong, Mechteld C.;Nathan, Hari;Pawlik, Timothy M.
PurposeTo确定与肝内胆管细胞癌（ICC）手术治疗后的结果相关的因素，并研究淋巴结（LN）评估对survival.Patients和MethodsFrom一个国际多机构数据库，449例谁接受了手术ICC 1973年至2010年之间的影响。采用单因素和多因素分析评价临床和病理资料。大多数患者为孤立性肿瘤（73%），无血管浸润（69%）。中位生存期为27个月，5年生存率为31%。与不良预后相关的因素包括切缘阳性状态（风险比[HR]，2.20; P <0.001）、多发病变（HR，1.80; P = 0.001）和血管侵犯（HR，1.59; P = 0.015）。肿瘤大小不是预后因素（HR，1.03; P = .23）。采用美国癌症联合委员会/国际抗癌联盟T1、T2 a和T2 b分类（第七版），以离散逐步方式对患者进行分层（P < .001）。248例患者（55%）进行了淋巴结切除术，其中74例（30%）有LN转移。LN转移与预后差相关（中位生存期：N 0，30个月vsN 1，24个月; P = 0.03）。虽然无淋巴结转移的患者可以根据肿瘤数量和血管浸润程度进行分层，（N0; P < .001），在N1疾病患者中，多发性肿瘤和血管侵犯，无论是单独还是共同，都不能将患者区分为离散的预后组结论尽管肿瘤大小不能提供预后信息，但肿瘤数量、血管浸润和LN转移与生存率相关。N1状态对总生存率有不利影响，也影响肿瘤数量和血管浸润对预后的相对影响。对于ICC，应强烈考虑淋巴结切除术，因为高达30%的患者会有LN转移。
PurposeTo identify factors associated with outcome after surgical management of intrahepatic cholangio-carcinoma (ICC) and examine the impact of lymph node (LN) assessment on survival.Patients and MethodsFrom an international multi-institutional database, 449 patients who underwent surgery for ICC between 1973 and 2010 were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses.Results Median tumor size was 6.5 cm. Most patients had a solitary tumor (73%) and no vascular invasion (69%). Median survival was 27 months, and 5-year survival was 31%. Factors associated with adverse prognosis included positive margin status (hazard ratio [HR], 2.20; P < .001), multiple lesions (HR, 1.80; P = .001), and vascular invasion (HR, 1.59; P = .015). Tumor size was not a prognostic factor (HR, 1.03; P = .23). Patients were stratified using the American Joint Committee on Cancer/International Union Against Cancer T1, T2a, and T2b categories (seventh edition) in a discrete step-wise fashion (P < .001). Lymphadenectomy was performed in 248 patients (55%); 74 of these (30%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0, 30 months v N1, 24 months; P = .03). Although patients with no LN metastasis were able to be stratified by tumor number and vascular invasion (N0; P < .001), among patients with N1 disease, multiple tumors and vascular invasion, either alone or together, failed to discriminate patients into discrete prognostic groups (P = .34).ConclusionAlthough tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. N1 status adversely affected overall survival and also influenced the relative effect of tumor number and vascular invasion on prognosis. Lymphadenectomy should be strongly considered for ICC, because up to 30% of patients will have LN metastasis.