Resection for Hilar Cholangiocarcinoma: Analysis of Prognostic Factors and the Impact of Systemic Inflammation on Long-term Outcome
Resection for Hilar Cholangiocarcinoma: Analysis of Prognostic Factors and the Impact of Systemic Inflammation on Long-term Outcome
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DOI：
10.1007/s11605-013-2144-2
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发表时间：
2013-05-01
影响因子：
3.2
通讯作者：
Popescu, Irinel
中科院分区：
文献类型：
--
作者：
Dumitrascu, Traian;Chirita, Dragos;Popescu, Irinel
肝门部胆管癌切除是长期生存的唯一希望。1996~2012年间，90例肝门部胆管癌患者接受了根治性手术。单因素分析(Kaplan-Meier曲线和对数等级检验)和多因素分析(Cox比例风险模型)评估了潜在的预后因素，中位总生存期和无瘤生存期分别为26个月和17个月。多因素分析显示R0切除(HR=0.03，95%CI0~0.19，p<；0.001)、尾状叶侵犯(HR=6.33，95%CI1.31~30.46，p=0.021)、吉西他滨辅助化疗(HR=0.38，95%CI0.15~0.94，p=0.037)和中性粒细胞/淋巴细胞比率(HR=0.78，95%CI0.62~0.98，p=0.036)是影响无病生存的独立预后因素。影响总生存率的独立预后因素为R0切除(HR=0.001.0 3，95%CI 0~0.2 2，P<0.0 1)、尾状叶侵犯(HR=11.75，95%CI 1.6 5~83.33，P=0.014)和吉西他滨辅助化疗(HR=0.19，95%CI 0.0 6~0.5 6，P=0.003)。以吉西他滨为基础的辅助化疗似乎有利于生存。中性粒细胞与淋巴细胞的比率可能被用来对患者进行分层，以用于未来的临床试验。
Resection for hilar cholangiocarcinoma is the single hope for long-term survival.Ninety patients underwent curative intent surgery for hilar cholangiocarcinoma between 1996 and 2012. The potential prognostic factors were assessed by univariate (Kaplan-Meier curves and log-rank test) and multivariate analyses (Cox proportional hazards model).The median overall and disease-free survivals were 26 and 17 months, respectively. The multivariate analysis identified R0 resection (HR = 0.03, 95 % CI 0-0.19, p < 0.001), caudate lobe invasion (HR = 6.33, 95 % CI 1.31-30.46, p = 0.021), adjuvant gemcitabine-based chemotherapy (HR = 0.38, 95 % CI 0.15-0.94, p = 0.037), and the neutrophil-to-lymphocyte ratio (HR = 0.78, 95 % CI 0.62-0.98, p = 0.036) as independent prognostic factors for disease-free survival. The independent prognostic factors for overall survival were R0 resection (HR = 0.03, 95 % CI 0-0.22, p < 0.001), caudate lobe invasion (HR = 11.75, 95 % CI 1.65-83.33, p = 0.014), and adjuvant gemcitabine-based chemotherapy (HR = 0.19, 95 % CI 0.06-0.56, p = 0.003).The negative resection margin represents the most important prognostic factor. Adjuvant gemcitabine-based chemotherapy appears to benefit survival. The neutrophil-to-lymphocyte ratio may potentially be used to stratify patients for future clinical trials.