Predictive Index for Tumor Recurrence after Liver Transplantation for Locally Advanced Intrahepatic and Hilar Cholangiocarcinoma
Predictive Index for Tumor Recurrence after Liver Transplantation for Locally Advanced Intrahepatic and Hilar Cholangiocarcinoma
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DOI：
10.1016/j.jamcollsurg.2010.12.005
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发表时间：
2011-04-01
影响因子：
5.2
通讯作者：
Busuttil, Ronald W.
中科院分区：
文献类型：
--
作者：
Hong, Johnny C.;Petrowsky, Henrik;Busuttil, Ronald W.
背景：目前胆管癌（CCA）原位肝移植（OLT）的标准仍然局限于早期和小肝门肿瘤，排除了局部晚期肝内和肝门CCA的潜在治愈患者。本研究旨在定义一种预后评分系统，用于肝内和肝门CCA患者的风险分层，这些患者可能受益于OLT，并允许扩展当前的OLT标准。研究设计：我们对1985年2月至2010年6月在我们中心接受OLT治疗局部晚期肝内和肝门CCA的40例患者进行了回顾性研究。中位随访时间为3年。采用Cox模型确定OLT后肿瘤复发的独立危险因素，并进行风险评分。对预测指数分类进行积分和分配：0 - 3为低风险，4 - 7为中等风险，8 - 15为高风险。结果：预测肿瘤复发的7个多因素包括多灶性肿瘤、神经周围浸润、浸润性生长方式、缺乏新辅助和辅助治疗、原发性硬化性胆管炎史、肝门肿瘤和淋巴血管浸润。低危组患者5年无肿瘤复发生存率（78%）显著高于中危组（19%）和高危组（0%）（p < 0.001）；与高危组相比，中危组的生存期也有所改善。结论：该模型可高度预测局部晚期肝内和肝门CCA OLT后的长期预后，可用于临床考虑进行OLT的患者的风险分层。低危组的长期无复发生存率很好，中危组也可以接受，证明扩大肝移植标准治疗这种具有挑战性的恶性肿瘤是合理的。[J]中华医学杂志，2011;22:514-521。(C) 2011年由美国外科医师学会发布)
BACKGROUND: Current criteria for orthotopic liver transplantation (OLT) for cholangiocarcinoma (CCA) remain restricted to early stage and small hilar tumors, excluding patients with locally advanced intrahepatic and hilar CCA for potential cure. The present study was undertaken to define a prognostic scoring system for risk stratification of patients with intrahepatic and hilar CCA who might benefit from OLT and to allow expansion of current OLT criteria.STUDY DESIGN: We conducted a retrospective review of 40 patients who underwent OLT for locally advanced intrahepatic and hilar CCA at our center between February 1985 and June 2010. Median follow-up was 3 years. Independent risk factors for tumor recurrence after OLT were identified using the Cox model and were assigned risk score points. Points were summed and assigned to predictive index categories: 0 to 3 for low risk, 4 to 7 for intermediate risk, and 8 to 15 for high risk.RESULTS: Seven multivariate factors predictive for tumor recurrence included multifocal tumor, perineural invasion, infiltrative growth pattern, lack of neoadjuvant and adjuvant therapy, history of primary sclerosing cholangitis, hilar tumors, and lymphovascular invasion. The 5-year tumor recurrence-free patient survival was significantly higher in low-risk (78%) compared with intermediate-(19%) and high-risk (0%) groups (p < 0.001); survival benefit was also seen in intermediate-compared with high-risk groups.CONCLUSIONS: This model was highly predictive of long-term outcomes after OLT for locally advanced intrahepatic and hilar CCA and can be applied clinically for risk stratification of patients considered for OLT. Long-term disease recurrence-free survival was excellent in low-risk and acceptable in intermediate-risk groups, justifying the expansion of liver transplant criteria for treatment of this challenging malignancy. (J Am Coll Surg 2011;212:514-521. (C) 2011 by the American College of Surgeons)