Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA 30322, USA.
HPB (Oxford). 2012 Aug;14(8):514-22. doi: 10.1111/j.1477-2574.2012.00489.x. Epub 2012 May 22.
Criteria for the selection of patients for adjuvant chemotherapy in intrahepatic cholangiocarcinoma (IHCC) are lacking. Some authors advocate treating patients with lymph node (LN) involvement; however, nodal assessment is often inadequate or not performed. This study aimed to identify surrogate criteria based on characteristics of the primary tumour.
A total of 58 patients who underwent resection for IHCC between January 2000 and January 2010 at any of three institutions were identified. Primary outcome was overall survival (OS).
Median OS was 23.0 months. Median tumour size was 6.5 cm and the median number of lesions was one. Overall, 16% of patients had positive margins, 38% had perineural invasion (PNI), 40% had lymphovascular invasion (LVI) and 22% had LN involvement. A median of two LNs were removed and a median of zero were positive. Lymph nodes were not sampled in 34% of patients. Lymphovascular and perineural invasion were associated with reduced OS [9.6 months vs. 32.7 months (P= 0.020) and 10.7 months vs. 32.7 months (P= 0.008), respectively]. Lymph node involvement indicated a trend towards reduced OS (10.7 months vs. 30.0 months; P= 0.063). The presence of either LVI or PNI in node-negative patients was associated with a reduction in OS similar to that in node-positive patients (12.1 months vs. 10.7 months; P= 0.541). After accounting for adverse tumour factors, only LVI and PNI remained associated with decreased OS on multivariate analysis (hazard ratio 4.07, 95% confidence interval 1.60-10.40; P= 0.003).
Lymphovascular and perineural invasion are separately associated with a reduction in OS similar to that in patients with LN-positive disease. As nodal dissection is often not performed and the number of nodes retrieved is frequently inadequate, these tumour-specific factors should be considered as criteria for selection for adjuvant chemotherapy.
肝内胆管癌（IHCC）辅助化疗患者的选择标准尚缺乏。一些作者主张对有淋巴结（LN）受累的患者进行治疗；然而，淋巴结评估通常不充分或未进行。本研究旨在基于肿瘤的特征确定替代标准。
在三个机构中的任何一个机构于 2000 年 1 月至 2010 年 1 月期间对接受 IHCC 切除术的 58 名患者进行了鉴定。主要结果是总生存期（OS）。
中位 OS 为 23.0 个月。中位肿瘤大小为 6.5cm，病变中位数为 1 个。总体而言，16%的患者切缘阳性，38%的患者有神经周围侵犯（PNI），40%的患者有淋巴血管侵犯（LVI），22%的患者有淋巴结受累。切除的 LN 中位数为 2 个，阳性 LN 中位数为 0 个。34%的患者未对淋巴结进行采样。淋巴血管和神经周围侵犯与降低的 OS 相关[9.6 个月与 32.7 个月（P=0.020）和 10.7 个月与 32.7 个月（P=0.008）]。淋巴结受累提示 OS 降低趋势（10.7 个月与 30.0 个月；P=0.063）。在淋巴结阴性患者中存在 LVI 或 PNI 与 OS 降低相关，与淋巴结阳性患者相似（12.1 个月与 10.7 个月；P=0.541）。在考虑到不良肿瘤因素后，只有 LVI 和 PNI 在多变量分析中与降低的 OS 相关（风险比 4.07，95%置信区间 1.60-10.40；P=0.003）。
淋巴血管和神经周围侵犯分别与 OS 降低相关，与 LN 阳性疾病患者相似。由于淋巴结清扫术通常不进行，并且取出的淋巴结数量经常不足，因此这些肿瘤特异性因素应被视为选择辅助化疗的标准。
