Hu Hai-Jie, Mao Hui, Shrestha Anuj, Tan Yong-Qiong, Ma Wen-Jie, Yang Qin, Wang Jun-Ke, Cheng Nan-Sheng, Li Fu-Yu
Hai-Jie Hu, Anuj Shrestha, Yong-Qiong Tan, Wen-Jie Ma, Qin Yang, Jun-Ke Wang, Nan-Sheng Cheng, Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China.
World J Gastroenterol. 2016 Feb 28;22(8):2601-10. doi: 10.3748/wjg.v22.i8.2601.
To evaluate the prognostic factors of hilar cholangiocarcinoma in a large series of patients in a single institution.
Eight hundred and fourteen patients with a diagnosis of hilar cholangiocarcinoma that were evaluated and treated between 1990 and 2014, of which 381 patients underwent curative surgery, were included in this study. Potential factors associated with overall survival (OS) and disease-free survival (DFS) were evaluated by univariate and multivariate analyses.
Curative surgery provided the best long-term survival with a median OS of 26.3 mo. The median DFS was 18.1 mo. Multivariate analysis showed that patients with tumor size > 3 cm [hazard ratio (HR) = 1.482, 95%CI: 1.127-1.949; P = 0.005], positive nodal disease (HR = 1.701, 95%CI: 1.346-2.149; P < 0.001), poor differentiation (HR = 2.535, 95%CI: 1.839-3.493; P < 0.001), vascular invasion (HR = 1.542, 95%CI: 1.082-2.197; P = 0.017), and positive margins (HR = 1.798, 95%CI: 1.314-2.461; P < 0.001) had poor OS outcome. The independent factors for DFS were positive nodal disease (HR = 3.383, 95%CI: 2.633-4.348; P < 0.001), poor differentiation (HR = 2.774, 95%CI: 2.012-3.823; P < 0.001), vascular invasion (HR = 2.136, 95%CI: 1.658-3.236; P < 0.001), and positive margins (HR = 1.835, 95%CI: 1.256-2.679; P < 0.001). Multiple logistic regression analysis showed that caudate lobectomy [odds ratio (OR) = 9.771, 95%CI: 4.672-20.433; P < 0.001], tumor diameter (OR = 3.772, 95%CI: 1.914-7.434; P < 0.001), surgical procedures (OR = 10.236, 95%CI: 4.738-22.116; P < 0.001), American Joint Committee On Cancer T stage (OR = 2.010, 95%CI: 1.043-3.870; P = 0.037), and vascular invasion (OR = 2.278, 95%CI: 0.997-5.207; P = 0.051) were independently associated with tumor-free margin, and surgical procedures could indirectly affect survival outcome by influencing the tumor resection margin.
Tumor margin, tumor differentiation, vascular invasion, and lymph node status were independent factors for OS and DFS. Surgical procedures can indirectly affect survival outcome by influencing the tumor resection margin.
在单一机构的大量患者中评估肝门部胆管癌的预后因素。
本研究纳入了1990年至2014年间评估并治疗的814例诊断为肝门部胆管癌的患者，其中381例患者接受了根治性手术。通过单因素和多因素分析评估与总生存期（OS）和无病生存期（DFS）相关的潜在因素。
根治性手术提供了最佳的长期生存，中位OS为26.3个月。中位DFS为18.1个月。多因素分析显示，肿瘤大小>3 cm的患者[风险比（HR）=1.482，95%CI：1.127-1.949；P=0.005]、有阳性淋巴结疾病（HR=1.701，95%CI：1.346-2.149；P<0.001）、低分化（HR=2.535，95%CI：1.839-3.493；P<0.001）、血管侵犯（HR=1.542，95%CI：1.082-2.197；P=0.017）和切缘阳性（HR=1.798，95%CI：1.314-2.461；P<0.001）的患者OS结局较差。DFS的独立因素为阳性淋巴结疾病（HR=3.383，95%CI：2.633-4.348；P<0.001）、低分化（HR=2.774，95%CI：2.012-3.823；P<0.001）、血管侵犯（HR=2.136，95%CI：1.658-3.236；P<0.001）和切缘阳性（HR=1.835，95%CI：1.256-2.679；P<0.001）。多因素logistic回归分析显示，尾状叶切除术[比值比（OR）=9.771，95%CI：4.672-20.433；P<0.001]、肿瘤直径（OR=3.772，95%CI：1.914-7.434；P<0.001）、手术方式（OR=10.236，95%CI：4.738-22.116；P<0.001）、美国癌症联合委员会T分期（OR=2.010，95%CI：1.043-3.870；P=0.037）和血管侵犯（OR=2.278，95%CI：0.997-5.207；P=0.051）与切缘阴性独立相关，且手术方式可通过影响肿瘤切除边缘间接影响生存结局。
肿瘤边缘、肿瘤分化、血管侵犯和淋巴结状态是OS和DFS的独立因素。手术方式可通过影响肿瘤切除边缘间接影响生存结局。
