Okabayashi T, Yamamoto J, Kosuge T, Shimada K, Yamasaki S, Takayama T, Makuuchi M
Department of Surgery, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo 104-0045, Japan.
Cancer. 2001 Nov 1;92(9):2374-83. doi: 10.1002/1097-0142(20011101)92:9<2374::aid-cncr1585>3.0.co;2-l.
The objective of this study was to analyze the clinicopathologic variables and the postoperative outcome in patients with mass-forming intrahepatic cholangiocarcinoma (ICC) to identify important factors for predicting postresection prognosis. Although it has been reported that mass-forming ICC has a different etiology and biologic features compared with hepatocellular carcinoma (HCC), patients with ICC have been dealt with clinicopathologically in the same manner as patients with HCC.
Sixty patients who underwent hepatectomy for mass-forming ICC with curative intent between 1981 and 1999 were studied. Fourteen preoperative clinical and diagnostic parameters and 12 postoperative surgicopathologic parameters were analyzed.
The rate of operative mortality in this patient cohort was 5%, and the overall 1-year, 3-year, and 5-year survival rates were 68%, 35%, and 29%, respectively, with a median survival of 19.6 months. A multivariate analysis revealed that independent negative prognostic factors were 1) hepatic regional lymph node metastasis, 2) multiple tumor presentation, 3) symptomatic tumor, and 4) the presence of vascular invasion. Using these factors, a new staging system was devised: Stage I disease was defined as a solitary tumor without vascular invasion, Stage II disease was defined as a solitary tumor with vascular invasion, Stage IIIA disease was defined as multiple tumors with or without vascular invasion, Stage IIIB disease was defined as any tumor with regional lymph node metastasis, and Stage IV disease was defined as any tumor with distant metastases. The Kaplan-Meier estimated 3-year survival rate and the median survival for each subgroup were 74% for patients with Stage I disease (median survival is the time when the cumulative survival rate of some patients' group declined to 50%; thus, the median survival could not be calculated in patients with Stage I disease because survival was 74% at the latest follow-up), 48% and 26.2 months for patients with Stage II disease, 18% and 16.8 months for patients with Stage IIIA disease, and 7% and 11.2 months for patients with Stage IIIB disease, respectively (P < 0.0001). None of the patients met the criteria for Stage IV disease.
The current results support the use of a new staging system for patients with ICC that is simple and predicts well the differences in survival after patients undergo hepatic resection.
本研究的目的是分析肿块型肝内胆管癌（ICC）患者的临床病理变量及术后结局，以确定预测切除术后预后的重要因素。尽管已有报道称，与肝细胞癌（HCC）相比，肿块型ICC具有不同的病因和生物学特征，但ICC患者在临床病理处理上与HCC患者相同。
研究了1981年至1999年间60例因肿块型ICC接受根治性肝切除术的患者。分析了14项术前临床和诊断参数以及12项术后手术病理参数。
该患者队列的手术死亡率为5%，1年、3年和5年总生存率分别为68%、35%和29%，中位生存期为19.6个月。多因素分析显示，独立的阴性预后因素为：1）肝区域淋巴结转移；2）多灶性肿瘤；3）有症状的肿瘤；4）血管侵犯。利用这些因素，设计了一种新的分期系统：I期疾病定义为无血管侵犯的孤立肿瘤；II期疾病定义为有血管侵犯的孤立肿瘤；IIIA期疾病定义为有或无血管侵犯的多灶性肿瘤；IIIB期疾病定义为有区域淋巴结转移的任何肿瘤；IV期疾病定义为有远处转移的任何肿瘤。Kaplan-Meier法估计各亚组的3年生存率及中位生存期：I期疾病患者为74%（中位生存期是指某患者组累积生存率降至50%时的时间；因此，I期疾病患者无法计算中位生存期，因为在最近一次随访时生存率为74%），II期疾病患者为48%和26.2个月，IIIA期疾病患者为18%和16.8个月，IIIB期疾病患者为7%和11.2个月（P<0.0001）。无患者符合IV期疾病标准。
目前的结果支持对ICC患者使用一种简单的新分期系统，该系统能很好地预测患者肝切除术后的生存差异。
