Kaiser Gernot M, Paul Andreas, Sgourakis George, Molmenti Ernesto P, Dechêne Alexander, Trarbach Tanja, Stuschke Martin, Baba Hideo A, Gerken Guido, Sotiropoulos Georgios C
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Am Surg. 2013 Jan;79(1):90-5.
Klatskin tumor is a rare hepatobiliary malignancy whose outcome and prognostic factors are not clearly documented. Between April 1998 and January 2007, 96 patients with hilar cholangiocarcinoma underwent resection. Data were collected prospectively. Thirty-one variables were evaluated for prognostic significance. There were 40 trisectionectomies, 40 hemihepatectomies, five central hepatectomies, and 11 biliary hilar resections. Thirty-seven (n = 37) patients required vascular reconstruction. There were 68 R0, 26 R1, and two R2 resections. Age (P = 0.048), pT status (P = 0.046), R class (P = 0.034), and adjuvant chemoradiation (P = 0.045) showed predictive significance by multivariate Cox proportional hazard regression analysis. A point scoring system was determined as follows: age younger than 62 years:age 62 years or older = 1:2 points; pT1:pT2 to 4 = 1:2 points; R0:R1/2 = 1:2 points; and chemoradiation yes:no = 1:2 points. The only model that reached statistical significance (P = 0.0332) described the following three groups: score 6 or less; score = 7; and score = 8. Median survival for score 6 or less, score = 7, and score = 8 was 26.5, 12, and 2.2 months, respectively (P = 0.032). The corresponding 1- and 3-year survival rates were 73 to 56 per cent, 52 to 38 per cent, and 17 to 0 per cent, respectively. We propose a scoring system predictive of long-term surgical outcome that could potentially improve patient selection for further postoperative oncologic treatment for Klatskin tumors.
肝门部胆管癌是一种罕见的肝胆恶性肿瘤，其预后及预后因素尚无明确记录。1998年4月至2007年1月期间，96例肝门部胆管癌患者接受了手术切除。数据为前瞻性收集。对31个变量进行了预后意义评估。其中有40例三段切除术、40例半肝切除术、5例中央肝切除术和11例肝门部胆管切除术。37例患者需要进行血管重建。有68例R0切除、26例R1切除和2例R2切除。多因素Cox比例风险回归分析显示，年龄（P = 0.048）、pT分期（P = 0.046）、R分级（P = 0.034）和辅助放化疗（P = 0.045）具有预测意义。确定的评分系统如下：年龄小于62岁：年龄62岁及以上 = 1:2分；pT1:pT2至4 = 1:2分；R0:R1/2 = 1:2分；放化疗是：否 = 1:2分。唯一具有统计学意义（P = 0.0332）的模型描述了以下三组：评分6分及以下；评分 = 7分；评分 = 8分。评分6分及以下、评分 = 7分和评分 = 8分的患者中位生存期分别为26.5个月、12个月和2.2个月（P = 0.032）。相应的1年和3年生存率分别为73%至56%、52%至38%和17%至0%。我们提出了一种预测长期手术结果的评分系统，该系统可能会改善肝门部胆管癌患者进一步术后肿瘤治疗的选择。
