Miyazaki Yoshihiro, Kokudo Takashi, Amikura Katsumi, Kageyama Yumiko, Takahashi Amane, Ohkohchi Nobuhiro, Sakamoto Hirohiko
Division of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan.
Department of Surgery, Clinical Sciences, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Jpn J Clin Oncol. 2017 Mar 1;47(3):206-212. doi: 10.1093/jjco/hyw182.
For recurrent biliary tract cancer, chemotherapy is the standard treatment. However, the efficacy of surgery is unknown. Here, the prognostic benefit of surgery for recurrent biliary tract cancer was investigated.
Data of 206 patients who underwent surgery for biliary tract cancer between 2005 and 2015 were retrospectively analyzed. Of these, 107 recurrent patients were divided into two groups, surgery (n = 14) and non-surgery (n = 93) groups. In the latter group, 45 patients received chemotherapy and 48 received best supportive care.
Of the total 121 sites of recurrence, the liver was the most common (n = 41), followed by locoregional recurrence (n = 32) and lymph nodes (n = 18). Surgery was performed in the 14 patients with recurrence, comprising nine patients with intrahepatic cholangiocarcinoma, three with perihilar cholangiocarcinoma, one with distal cholangiocarcinoma and one with gallbladder carcinoma. Survival after recurrence was significantly better after surgery than after chemotherapy or best supportive care (38% vs. 5.3% vs. 0% at 3 years and 19% vs. 5.3% vs. 0% at 5 years; P < 0.0001). Multivariate analysis identified the residual status of the primary tumor (hazard ratio = 1.58, 95% confidence interval = 1.00-2.44; P = 0.047), time to recurrence ≥1 year (hazard ratio = 0.62, 95% confidence interval = 0.39-0.97; P = 0.037) and surgery for recurrence (hazard ratio = 0.32, 95% confidence interval = 0.14-0.62; P < 0.001) as independent prognostic factors.
Surgery for recurrent biliary tract cancer may prolong survival in patients with time to recurrence ≥1 year.
对于复发性胆管癌，化疗是标准治疗方法。然而，手术的疗效尚不清楚。在此，我们研究了复发性胆管癌手术的预后益处。
回顾性分析了2005年至2015年间接受胆管癌手术的206例患者的数据。其中，107例复发患者分为两组，手术组（n = 14）和非手术组（n = 93）。在非手术组中，45例患者接受了化疗，48例接受了最佳支持治疗。
在总共121个复发部位中，肝脏是最常见的（n = 41），其次是局部复发（n = 32）和淋巴结（n = 18）。14例复发患者接受了手术，其中9例为肝内胆管癌，3例为肝门周围胆管癌，1例为远端胆管癌，1例为胆囊癌。复发后的生存期在手术后明显优于化疗或最佳支持治疗（3年时分别为38%、5.3%、0%；5年时分别为19%、5.3%、0%；P < 0.0001）。多因素分析确定原发肿瘤的残留状态（风险比 = 1.58，95%置信区间 = 1.00 - 2.44；P = 0.047）、复发时间≥1年（风险比 = 0.62，95%置信区间 = 0.39 - 0.97；P = 0.037）和复发手术（风险比 = 0.32，95%置信区间 = 0.14 - 0.62；P < 0.001）为独立预后因素。
复发性胆管癌手术可能会延长复发时间≥1年患者的生存期。
