Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
J Surg Oncol. 2012 Jan;105(1):91-6. doi: 10.1002/jso.22054. Epub 2011 Aug 3.
Patients with peri-hilar cholangiocarcinoma who undergo R1 resection with curative intent will have an improved survival compared to patients who were not resected.
Review of a prospective hepatobiliary database identified 130 patients. Survival was compared using the log-rank test.
Seventy-nine patients (61%) were resected while 51 (49%) patients were not. Forty-two patients (54%) had an R0 resection. There was no difference in mean age (69 vs. 67; P = 0.8), BMI (27.8 vs. 27.9; P = 1.0), gender (73% vs. 43% male; P = 0.1), presence of jaundice (77% vs. 64%; P = 0.5), vascular involvement on pre operative imaging (77% vs. 64%; P = 0.5), stent (73.1% vs. 64.3%; P = 0.72), and lobar atrophy (27% vs. 7%, P = 0.2) in the resected versus non-resected patients. All patients underwent chemotherapy and/or radiation therapy. After a median follow up of 35.6 months the median OSl for all peri-hilar patients was 16.2 months (95% CI = 11.2-23.4). The median OS for resected patients was 18.9 months (95% CI = 12.5-24.7) versus 5.0 months (95% CI = 0-6.9) for patients not resected (P < 0.001). The only pre-operative predictor of OS was resection (P = 0.041). Vascular invasion, lobar atrophy, and stent placement were not statistically significant predictors.
Overall survival is improved in patients undergoing R1 resection and multi-modality therapy compared to patients not resected.
接受根治性 R1 切除术的肝门周围胆管癌患者的生存情况优于未接受切除术的患者。
回顾性分析前瞻性肝胆数据库中确定的 130 例患者。采用对数秩检验比较生存情况。
79 例（61%）患者接受了切除术，51 例（49%）患者未接受切除术。42 例（54%）患者行 R0 切除术。两组患者的平均年龄（69 岁比 67 岁；P=0.8）、BMI（27.8 比 27.9；P=1.0）、性别（73%比 43%为男性；P=0.1）、术前影像学检查中是否存在黄疸（77%比 64%；P=0.5）、血管受累（77%比 64%；P=0.5）、支架（73.1%比 64.3%；P=0.72）和肝叶萎缩（27%比 7%，P=0.2）差异均无统计学意义。所有患者均接受了化疗和/或放疗。中位随访 35.6 个月后，所有肝门周围胆管癌患者的中位总生存率为 16.2 个月（95%CI=11.2-23.4）。接受切除术患者的中位总生存期为 18.9 个月（95%CI=12.5-24.7），而未接受切除术患者的中位总生存期为 5.0 个月（95%CI=0-6.9）（P<0.001）。唯一与 OS 相关的术前预测因素是切除术（P=0.041）。血管侵犯、肝叶萎缩和支架置入不是统计学上的显著预测因素。
与未接受切除术的患者相比，接受 R1 切除术和多模式治疗的患者总生存率提高。
