肝门部和肝内胆管癌外科治疗中淋巴结清扫的模式和预后意义。
Patterns and prognostic significance of lymph node dissection for surgical treatment of perihilar and intrahepatic cholangiocarcinoma.
机构信息
Division of General Surgery "A," Unit of HPB Surgery, Department of Surgery, "GB Rossi" University Hospital, University of Verona, 37134, Verona, Italy.
出版信息
J Gastrointest Surg. 2013 Nov;17(11):1917-28. doi: 10.1007/s11605-013-2331-1. Epub 2013 Sep 19.
INTRODUCTION
The prognostic significance of lymph node dissection (LND), the number and status of harvested lymph nodes (LNs), and the lymph node ratio (LNR) are still under debate in intrahepatic (ICC) and perihilar (PCC) cholangiocarcinoma. The aims of this study were to evaluate the prognostic value of the extent of LN dissection, the number of positive LNs, the distribution of positive LNs along different LN stations, and the LNR in a cohort of patients with ICC and PCC who underwent surgical resection and to compare the different prognostic values of lymph node involvement.
MATERIAL AND METHODS
A retrospective analysis was done evaluating extent of LND, number, status, and location of harvested LNs in a cohort of 145 patients with cholangiocarcinoma submitted to surgical resection with curative intent from 1990 to 2012.
RESULTS
Seventy patients had ICC and 75 had PCC. The median survival times of patients with N0 and N+ tumors were 42 and 19 months in ICC patients (p = 0.05) and 42 and 22 months in PCC patients (p = 0.01). In patients without LN metastases, the median survival times of patients with up to three LNs retrieved and with more than three LNs retrieved were 38 and 69 months in ICC patients (p = 0.05) and 18 and 43 months in PCC patients (p = 0.04), respectively. In N+ patients, the location of positive LNs (hepatoduodenal ligament or other regional stations) did not influence overall survival in ICC or PCC patients (p = 0.6). The median survival times of patients with LNRs of 0 and >0.25 were 43 and 19 months in ICC patients (p = 0.01); the 0-0.25 group did not reach the value. In PCC patients, median survival of 0, 0-0.25, and >0.25 groups of patients were 42, 23, and 11 months (p = 0.01), respectively.
CONCLUSIONS
LN metastasis is a major prognostic factor after surgical resection of cholangiocarcinoma. The number of harvested LNs and the LNR showed a high prognostic value in ICC and PCC.
介绍
淋巴结清扫（LND）的预后意义、采集的淋巴结（LNs）的数量和状态以及淋巴结比率（LNR）在肝内（ICC）和肝门部（PCC）胆管癌中仍存在争议。本研究的目的是评估 ICC 和 PCC 患者接受根治性手术切除后淋巴结清扫范围、阳性淋巴结数量、阳性淋巴结沿不同淋巴结站的分布以及 LNR 的预后价值，并比较不同淋巴结受累的预后价值。
材料与方法
对 1990 年至 2012 年期间接受根治性手术切除的 145 例胆管癌患者的 LND 范围、数量、状态和采集的 LNs 位置进行回顾性分析。
结果
70 例为 ICC，75 例为 PCC。N0 和 N+肿瘤患者的中位生存时间分别为 ICC 患者 42 个月和 19 个月（p=0.05），PCC 患者 42 个月和 22 个月（p=0.01）。在无淋巴结转移的患者中，ICC 患者中获取 3 个及以上淋巴结的患者中位生存时间为 38 个月和 69 个月（p=0.05），PCC 患者为 18 个月和 43 个月（p=0.04）。在 N+患者中，阳性淋巴结（肝十二指肠韧带或其他区域站）的位置对 ICC 或 PCC 患者的总生存无影响（p=0.6）。ICC 患者中 LNR 为 0 和>0.25 的患者中位生存时间分别为 43 个月和 19 个月（p=0.01）；0-0.25 组未达到该值。PCC 患者的中位生存时间为 0、0-0.25 和>0.25 组分别为 42、23 和 11 个月（p=0.01）。
结论
淋巴结转移是胆管癌根治性切除术后的主要预后因素。ICC 和 PCC 中，采集的淋巴结数量和 LNR 具有较高的预后价值。
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