Hwang Shin, Lee Young-Joo, Song Gi-Won, Park Kwang-Min, Kim Ki-Hun, Ahn Chul-Soo, Moon Deok-Bog, Lee Sung-Gyu
Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, South Korea,
J Gastrointest Surg. 2015 Jul;19(7):1291-304. doi: 10.1007/s11605-015-2803-6. Epub 2015 Mar 28.
Because noticeable changes were made to the 7th American Joint Committee on Cancer (AJCC) tumor-node-metastasis (TNM) staging for intrahepatic cholangiocarcinoma (IHCC), we validated the prognostic impact of tumor staging after macroscopic curative resection of IHCC.
A cohort of 659 IHCC patients who underwent R0 (n = 539) or R1 (n = 120) resection were selected with exclusion of R2 resection (n = 111). Study patients were followed up for ≥24 months or until death with no patient lost during survival analysis.
Anatomical resection was performed in 599 (90.9%) and concurrent bile duct resection was conducted in 97 (14.7%). Median survival periods following R0, R1, and R2 resections were 28, 12, and 3 months, respectively (p = 0.000). In the R0 resection group, the 1-, 3-, 5-, and 10-year tumor recurrence rates were 36.4%, 57.9%, 64.7%, and 65.0%, respectively, and the 1-, 3-, 5-, and 10-year patient survival rates were 73.1%, 44.2%, 33.0%, and 23.1%, respectively. Independent risk factors for tumor recurrence and patient survival were tumor growth type, tumor size > 5 cm, perineural invasion, and lymph node metastasis. According to the 7th AJCC staging system, the prognostic contrast was marginal in stage T2-4 tumors without lymph node metastasis (p > 0.8). With our redefined staging system with tumor growth types and risk factors including tumor number and perineural/lymphovascular invasion, clear prognostic contrast was achieved among T1-3 stages (p = 0.000).
Growth type of IHCC seems to be essential for determining tumor stage. Although the stratification of the 7th AJCC IHCC staging system seems reasonably established, refinements and further validation could improve prognostic predictability.
由于美国癌症联合委员会（AJCC）第7版肝内胆管癌（IHCC）肿瘤-淋巴结-转移（TNM）分期有显著变化，我们对IHCC宏观根治性切除术后肿瘤分期的预后影响进行了验证。
选取659例行R0（n = 539）或R1（n = 120）切除的IHCC患者，排除R2切除患者（n = 111）。对研究患者进行≥24个月的随访或直至死亡，生存分析期间无患者失访。
599例（90.9%）患者接受了解剖性切除，97例（14.7%）患者同时进行了胆管切除。R0、R1和R2切除术后的中位生存期分别为28个月、12个月和3个月（p = 0.000）。在R0切除组中，1年、3年、5年和10年的肿瘤复发率分别为36.4%、57.9%、64.7%和65.0%，1年、3年、5年和10年的患者生存率分别为73.1%、44.2%、33.0%和23.1%。肿瘤复发和患者生存的独立危险因素为肿瘤生长类型、肿瘤大小>5 cm、神经周围侵犯和淋巴结转移。根据第7版AJCC分期系统，在无淋巴结转移的T2-4期肿瘤中，预后差异不显著（p>0.8）。采用我们重新定义的分期系统，纳入肿瘤生长类型以及包括肿瘤数量和神经周围/淋巴管侵犯等危险因素后，T1-3期之间有明显的预后差异（p = 0.000）。
IHCC的生长类型似乎是确定肿瘤分期的关键因素。虽然第7版AJCC IHCC分期系统的分层似乎合理，但进一步完善和验证可提高预后预测能力。
