Todoroki T, Kawamoto T, Koike N, Fukao K, Shoda J, Takahashi H
Department of Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba-Shi, Japan.
Br J Surg. 2001 Mar;88(3):364-70. doi: 10.1046/j.1365-2168.2001.01685.x.
The prognosis for patients with middle and lower third bile duct carcinoma remains poor. This study was conducted to identify independent predictors for survival, as well as the patterns of recurrence after curative resection.
Sixty-seven patients with pathologically verified middle and/or lower third bile duct carcinoma were analysed retrospectively by Cox regression analysis for predictors of survival.
The overall 5-year survival rate after resection was 39 per cent, and 0 per cent for patients who did not undergo resection. The 5-year survival rate was 63 per cent in 26 patients without microscopic residual disease (R0), 16 per cent in 25 patients with microscopic residual tumour (R1) and 0 per cent in six patients with macroscopic residual tumour (R2); ten patients did not undergo resection. Radiotherapy improved the 5-year survival rate in eight patients who had R1 resection compared with the rate in 17 patients who underwent resection alone (8 versus 0), but not significantly so (P = 0.137); however, median survival was significantly longer (P = 0.004) in six patients who had R2 resection compared with that in ten inoperable patients (11.4 versus 3.5 months). Multivariate analysis revealed that the primary tumour and tumour node metastasis (TNM) stage were independent predictors of survival; 13 clinicopathological factors were not independent prognostic factors. Of 26 patients having R0 resection, one had a locoregional relapse only, six had distant metastases only, and five had both types of recurrence. The liver was the most frequent site for metastasis, and microscopic venous invasion (MVI) in the primary tumour was a significant predictor of liver metastasis.
Curative (R0) resection is only one step in curing cancer, and radiotherapy may play a beneficial role in controlling locoregional residual tumour. MVI could be a useful indicator of when systemic adjuvant therapy should be implemented to prevent liver metastasis after R0 resection, although no effective systemic treatment has yet been developed.
中下段胆管癌患者的预后仍然很差。本研究旨在确定生存的独立预测因素以及根治性切除术后的复发模式。
对67例经病理证实的中下段胆管癌患者进行回顾性分析，采用Cox回归分析生存预测因素。
切除术后总体5年生存率为39%，未接受切除的患者为0%。26例无微小残留病灶（R0）患者的5年生存率为63%，25例有微小残留肿瘤（R1）患者为16%，6例有肉眼残留肿瘤（R2）患者为0%；10例患者未接受切除。与17例单纯接受切除的患者相比，放疗提高了8例接受R1切除患者的5年生存率（分别为8%和0%），但差异无统计学意义（P = 0.137）；然而，6例接受R2切除患者的中位生存期明显长于10例无法手术患者（11.4个月对3.5个月，P = 0.004）。多因素分析显示，原发肿瘤和肿瘤淋巴结转移（TNM）分期是生存的独立预测因素；13个临床病理因素不是独立的预后因素。在26例接受R0切除的患者中，1例仅发生局部复发，6例仅发生远处转移，5例两种类型的复发均有。肝脏是最常见的转移部位，原发肿瘤中的微小静脉侵犯（MVI）是肝转移的重要预测因素。
根治性（R0）切除只是治愈癌症的第一步，放疗可能在控制局部残留肿瘤方面发挥有益作用。MVI可能是R0切除后何时应实施全身辅助治疗以预防肝转移的有用指标，尽管尚未开发出有效的全身治疗方法。
