Department of Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
World J Surg. 2012 Sep;36(9):2179-86. doi: 10.1007/s00268-012-1638-5.
Radical resection remains the only curative treatment for hilar cholangiocarcinoma (HCCA). Only a limited proportion of patients, however, are eligible for resection. The survival and prognostic factors of these patients are largely unknown. The aim of this study was to evaluate survival and prognostic factors in unresectable patients presenting with HCCA.
We performed a cohort study of the denominator of HCCA patients seen in a tertiary referral center between March 2003 and March 2009. Demographics, treatment, pathology results, and survival were analyzed.
A total of 217 patients with suspected HCCA were identified. Ninety-five patients (40 %) underwent laparotomy, and in 57 (63 %) of these patients resection was performed. Overall median and 5-year survival of resected patients were 37 months and 43 %, respectively, as compared to 13 months and 7 % in unresectable patients. In unresectable patients, median survival was better in patients with locally advanced disease (16 months) as compared to patients with hepatic and extrahepatic metastases (5 and 3 months, p < 0.001). Of the 160 unresectable patients, 17 (10 %) survived longer than 3 years.
Of the patients presenting with HCCA in our center, 26 % proved resectable. The 7 % long-term survival rate of unresectable patients is remarkable and emphasizes the indolent growth of some of these tumors. Patients with metastases had a much worse prognosis with a median of 4 months.
根治性切除术仍然是治疗肝门部胆管癌（HCCA）的唯一方法。然而，只有有限比例的患者适合进行切除术。这些患者的生存和预后因素在很大程度上尚不清楚。本研究旨在评估不能切除的 HCCA 患者的生存和预后因素。
我们对 2003 年 3 月至 2009 年 3 月在一家三级转诊中心就诊的 HCCA 患者进行了队列研究。分析了人口统计学、治疗、病理学结果和生存情况。
共确定了 217 例疑似 HCCA 的患者。95 例患者（40%）接受了剖腹手术，其中 57 例（63%）患者进行了切除术。与不可切除患者的 13 个月和 7%相比，可切除患者的总中位生存期和 5 年生存率分别为 37 个月和 43%。在不可切除的患者中，局部晚期疾病患者的中位生存期优于肝内和肝外转移患者（16 个月、5 个月和 3 个月，p < 0.001）。在 160 例不可切除的患者中，有 17 例（10%）存活时间超过 3 年。
在我们中心就诊的 HCCA 患者中，26%的患者可切除。不可切除患者的 7%的长期生存率是显著的，这强调了这些肿瘤中的一些生长较为缓慢。转移患者的预后更差，中位生存期为 4 个月。
