Ma Ka Wing, Cheung Tan To, She Wong Hoi, Chok Kenneth S H, Chan Albert Chi Yan, Ng Irene Oi Lin, Chan See Ching, Lo Chung Mau
Department of Surgery, The University of Hong Kong State Key Laboratory for Liver Research, The University of Hong Kong Department of Pathology, The University of Hong Kong, Hong Kong, China.
Medicine (Baltimore). 2016 Jul;95(28):e4133. doi: 10.1097/MD.0000000000004133.
Prognosis of intrahepatic cholangiocarcinoma (ICC) remained poor despite the multitude advancement of medical care. Resection margin status is one of the few modifiable factors that a surgeon could possibly manipulate to alter the disease outcome. However, the significance of margin status and margin width is still controversial. This study serves to further elucidate the role of them.
This is a retrospective cohort from the Queen Mary Hospital, The University of Hong Kong. Consecutive patients diagnosed to have ICC and with surgical resection performed in curative intent were retrieved, while patients with cholangiohepatocellular carcinoma, Klaskin tumor, tumor of extrahepatic bile duct, and uncertain tumor pathology were excluded.
From 1991 to 2013, there were 107 patients underwent hepatectomy for ICC. Gender predilection was not observed with 58 males and 49 females, median age of the patients was 61. The median tumor size was 6 cm and most of them (43%) were moderately differentiated adenocarcinoma. Clear resection margin were achieved in 95 patients (88.8%) and the median margin width was 0.5 cm. The hospital length of stay and operative mortality were 11 days and 3%, respectively. The disease-free survival and overall survival were 17.5 and 25.1 months, respectively. Multivariate analysis showed that margin width was an independent factor associated with disease-free survival (P = 0.015, 95% confidence interval [CI] 0.4-0.9). Subgroup analysis in patients with solitary tumor showed that margin width is an independent factor affecting overall survival (P = 0.048; odds ratio: 0.577; 95% CI: 0.334-0.996). Discriminant analysis showed that the overall survival increased from 36 to 185 months when margin width was >0.9 cm (P = 0.025) in patients with solitary tumor.
Aggressive resection to achieve resection margin of at least 1 cm maximizes chance of cure in patients with early ICC.
尽管医疗水平有了诸多进步，但肝内胆管癌（ICC）的预后仍然很差。切缘状态是外科医生可能用以改变疾病预后的少数可调节因素之一。然而，切缘状态和切缘宽度的重要性仍存在争议。本研究旨在进一步阐明它们的作用。
这是一项来自香港大学玛丽医院的回顾性队列研究。检索出连续诊断为ICC并接受了根治性手术切除的患者，同时排除胆管肝细胞癌、克拉斯金瘤、肝外胆管肿瘤及肿瘤病理不明确的患者。
1991年至2013年，有107例患者因ICC接受了肝切除术。未观察到性别偏好，男性58例，女性49例，患者中位年龄为61岁。肿瘤中位大小为6厘米，其中大多数（43%）为中分化腺癌。95例患者（88.8%）实现了切缘阴性，切缘中位宽度为0.5厘米。住院时间中位数和手术死亡率分别为11天和3%。无病生存期和总生存期分别为17.5个月和25.1个月。多因素分析显示，切缘宽度是与无病生存期相关的独立因素（P = 0.015，95%置信区间[CI] 0.4 - 0.9）。对孤立肿瘤患者的亚组分析显示，切缘宽度是影响总生存期的独立因素（P = 0.048；比值比：0.577；95% CI：0.334 - 0.996）。判别分析显示，孤立肿瘤患者切缘宽度>0.9厘米时，总生存期从36个月增加到185个月（P = 0.025）。
积极切除以实现至少1厘米的切缘可使早期ICC患者的治愈机会最大化。
