Shaib Yasser H, Davila Jessica A, Henderson Louise, McGlynn Katherine A, El-Serag Hashem B
Sections of Health Services, Houston, TX, USA.
J Clin Gastroenterol. 2007 Nov-Dec;41(10):911-7. doi: 10.1097/MCG.0b013e31802f3132.
Intrahepatic cholangiocarcinoma (ICC) is a highly fatal disease with limited therapeutic options. The determinants, trends, and outcomes of different therapies for ICC are largely unknown in the United States.
Using data from the Surveillance, Epidemiology, and End-Results-(SEER) Medicare database, we compared ICC patients receiving different therapies between 1992 and 1999. Univariate and multivariate analyses were performed and adjusted odds ratios (AORs) were calculated. Hazard ratios were calculated for the survival analysis.
Eight hundred sixty-two cases were included. The mean age at diagnosis was 77.9 years (SD=7.1). Only 6.3% received surgical resection, 65.5% received palliative interventions (16.1% surgical, 44.0% endoscopic), 24.4% received only chemo or radiation therapy whereas 3.8% did not receive any treatment. The median survival was 708 days [95% confidence interval (CI): 458-945] for surgical resection, 227 days (95% CI: 182-294) for surgical palliation, and 123 days (95% CI: 108-148) for endoscopic palliation. Patients receiving surgical resection were younger (AOR=5.6, 95% CI: 2.9-11.1), more likely to be diagnosed later in the study period (AOR=2.2, 95% CI: 1.1-4.2), and had better mortality (hazard ratio=0.3, 95% CI: 0.2-0.4). Patients receiving surgical palliation were younger (AOR=1.6, 95% CI: 1.1-2.3), more likely to be diagnosed in the early time period (AOR=1.5, 95% CI: 1.1-2.2), and had similar mortality to those receiving endoscopic palliation.
Only a minority of patients with ICC receives potentially curative therapy. Young age is the strongest predictor of receiving potentially curative treatment. Older patients and those diagnosed in recent time periods are more likely to receive endoscopic palliation. Surgical resection was associated with improved survival. There was no difference in survival between surgical and endoscopic palliation.
肝内胆管癌（ICC）是一种致死率很高的疾病，治疗选择有限。在美国，ICC不同治疗方法的决定因素、趋势和结果在很大程度上尚不清楚。
利用监测、流行病学和最终结果（SEER）医疗保险数据库的数据，我们比较了1992年至1999年间接受不同治疗的ICC患者。进行了单因素和多因素分析，并计算了调整后的优势比（AOR）。计算生存分析的风险比。
共纳入862例病例。诊断时的平均年龄为77.9岁（标准差=7.1）。仅6.3%的患者接受了手术切除，65.5%的患者接受了姑息性干预（16.1%为手术，44.0%为内镜），24.4%的患者仅接受化疗或放疗，而3.8%的患者未接受任何治疗。手术切除患者的中位生存期为708天[95%置信区间（CI）：458-945]，手术姑息治疗患者为227天（95%CI：182-294），内镜姑息治疗患者为123天（95%CI：108-148）。接受手术切除的患者更年轻（AOR=5.6，95%CI：2.9-11.1），在研究期间更可能在后期被诊断（AOR=2.2，95%CI：1.1-4.2），死亡率更低（风险比=0.3，95%CI：0.2-0.4）。接受手术姑息治疗的患者更年轻（AOR=1.6，95%CI：1.1-2.3），更可能在早期被诊断（AOR=1.5，95%CI：1.1-2.2），其死亡率与接受内镜姑息治疗的患者相似。
只有少数ICC患者接受了可能治愈的治疗。年轻是接受可能治愈性治疗的最强预测因素。老年患者和近期诊断的患者更可能接受内镜姑息治疗。手术切除与生存率提高相关。手术姑息治疗和内镜姑息治疗的生存率没有差异。
