Spolverato Gaya, Kim Yuhree, Alexandrescu Sorin, Popescu Irinel, Marques Hugo P, Aldrighetti Luca, Clark Gamblin T, Miura John, Maithel Shishir K, Squires Malcolm H, Pulitano Carlo, Sandroussi Charbel, Mentha Gilles, Bauer Todd W, Newhook Timothy, Shen Feng, Poultsides George A, Wallis Marsh J, Pawlik Timothy M
The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2015 Jul;22(7):2218-25. doi: 10.1245/s10434-014-4223-3. Epub 2014 Oct 30.
The role of surgical resection for patients with large or multifocal intrahepatic cholangiocarcinoma (ICC) remains unclear. This study evaluated the long-term outcome of patients who underwent hepatic resection for large (≥7 cm) or multifocal (≥2) ICC.
Between 1990 and 2013, 557 patients who underwent liver resection for ICC were identified from a multi-institutional database. Clinicopathologic characteristics, operative details, and long-term survival data were evaluated.
Of the 557 patients, 215 (38.6 %) had a small, solitary ICC (group A) and 342 (61.4 %) had a large or multifocal ICC (group B). The patients in group B underwent an extended hepatectomy more frequently (16.9 vs. 30.4 %; P < 0.001). At the final pathology exam, the patients in group B were more likely to show evidence of vascular invasion (22.5 vs. 38.5 %), direct invasion of contiguous organs (6.5 vs. 12.9 %), and nodal metastasis (13.3 vs. 21.0 %) (all P < 0.05). Interestingly, the incidences of postoperative complications (39.3 vs. 46.8 %) and hospital mortality (1.1 vs. 3.7 %) were similar between the two groups (both P > 0.05). The group A patients had better rates for 5-year overall survival (OS) (30.5 vs. 18.7 %; P < 0.05) and disease-free survival (DFS) (22.6 vs. 8.2 %; P < 0.05) than the group B patients. For the patients in group B, the factors associated with a worse OS included more than three tumor nodules [hazard ratio (HR), 1.56], nodal metastasis (HR, 1.47), and poor differentiation (HR, 1.48).
Liver resection can be performed safely for patients with large or multifocal ICC. The long-term outcome for these patients can be stratified on the basis of a prognostic score that includes tumor number, nodal metastasis, and poor differentiation.
手术切除对于大的或多灶性肝内胆管癌（ICC）患者的作用仍不明确。本研究评估了接受肝切除治疗大的（≥7 cm）或多灶性（≥2个）ICC患者的长期预后。
1990年至2013年间，从一个多机构数据库中识别出557例接受肝切除治疗ICC的患者。对其临床病理特征、手术细节和长期生存数据进行评估。
557例患者中，215例（38.6%）患有小的孤立性ICC（A组），342例（61.4%）患有大的或多灶性ICC（B组）。B组患者更频繁地接受扩大肝切除术（16.9%对30.4%；P<0.001）。在最终病理检查中，B组患者更有可能出现血管侵犯（22.5%对38.5%）、邻近器官直接侵犯（6.5%对12.9%）和淋巴结转移（13.3%对21.0%）（所有P<0.05）。有趣的是，两组患者术后并发症发生率（39.3%对46.8%）和医院死亡率（1.1%对3.7%）相似（均P>0.05）。A组患者的5年总生存率（OS）（30.5%对18.7%；P<0.05）和无病生存率（DFS）（22.6%对8.2%；P<0.05）均优于B组患者。对于B组患者，与较差OS相关的因素包括超过三个肿瘤结节[风险比（HR），1.56]、淋巴结转移（HR，1.47）和低分化（HR，1.48）。
对于大的或多灶性ICC患者可以安全地进行肝切除。这些患者的长期预后可以根据包括肿瘤数量、淋巴结转移和低分化的预后评分进行分层。
