Yamashita Suguru, Koay Eugene Jon, Passot Guillaume, Shroff Rachna, Raghav Kanwal P, Conrad Claudius, Chun Yun Shin, Aloia Thomas A, Tao Randa, Kaseb Ahmed, Javle Milind, Crane Christopher H, Vauthey Jean-Nicolas
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA.
Cancer. 2017 Apr 15;123(8):1354-1362. doi: 10.1002/cncr.30488. Epub 2016 Dec 16.
Treatment methods for intrahepatic cholangiocarcinoma (ICC) have improved, but their impact on outcome remains unclear. We evaluated the outcomes of patients definitively treated with resection, radiation, and chemotherapy for ICC, stratified by era.
Clinico-pathologic characteristics, cause of death, disease-specific survival (DSS), and intrahepatic progression-free survival (IPFS) were compared among patients who underwent resection, radiation, or chemotherapy as definitive treatment strategies for ICC (without distant organ metastasis) between 1997 and 2015. Variables were also analyzed by era (1997-2006 [early] or 2007-2015 [late]) within each group.
Among 362 patients in our cohort, 122 underwent resection (early, 38; late, 84), 85 underwent radiation (early, 17; late, 68), and 148 underwent systemic chemotherapy alone (early, 51; late, 97) as definitive treatment strategies, and 7 patients received best supportive care. In the resection group, the 3-year DSS rate was 58% for the early era and 67% for the late era (P = .036), and the 1-year IPFS was 50% for the early era and 75% for the late era (P = .048). In the radiation group, the 3-year DSS was 12% for the early era and 37% for the late era (P = .048), and the 1-year IPFS was 48% for the early era and 64% for the late era (P = .030). In the chemotherapy group, DSS and IPFS did not differ by era. Patients treated with chemotherapy developed liver failure at the time of death significantly more frequently than patients treated with resection (P < .001) or radiation (P < .001). Multivariable analysis identified local therapy (resection or radiation) as a sole predictor of death without liver failure.
Survival outcomes have improved for local therapy-based definitive treatment strategies for ICC, which may be attributable to maintaining control of intrahepatic disease, thereby reducing the occurrence of death due to liver failure. Cancer 2017;123:1354-1362. © 2016 American Cancer Society.
肝内胆管癌（ICC）的治疗方法已有所改进，但其对预后的影响仍不明确。我们评估了接受手术、放疗和化疗作为根治性治疗的ICC患者的预后，并按年代进行分层。
比较了1997年至2015年间接受手术、放疗或化疗作为ICC（无远处器官转移）根治性治疗策略的患者的临床病理特征、死亡原因、疾病特异性生存（DSS）和肝内无进展生存（IPFS）。还对每组内的年代（1997 - 2006年[早期]或2007 - 2015年[晚期]）进行了变量分析。
在我们队列中的362例患者中，122例接受了手术（早期38例，晚期84例），85例接受了放疗（早期17例，晚期68例），148例仅接受了全身化疗（早期51例，晚期97例）作为根治性治疗策略，7例接受了最佳支持治疗。在手术组中，早期3年DSS率为58%，晚期为67%（P = 0.036），早期1年IPFS为50%，晚期为75%（P = 0.048）。在放疗组中，早期3年DSS为12%，晚期为37%（P = 0.048），早期1年IPFS为48%，晚期为64%（P = 0.030）。在化疗组中，DSS和IPFS在不同年代无差异。接受化疗的患者在死亡时出现肝衰竭的频率明显高于接受手术（P < 0.001）或放疗（P < 0.001）的患者。多变量分析确定局部治疗（手术或放疗）是无肝衰竭死亡的唯一预测因素。
基于局部治疗的ICC根治性治疗策略的生存预后有所改善，这可能归因于维持对肝内疾病的控制，从而减少因肝衰竭导致的死亡发生。《癌症》2017年；123:1354 - 1362。©2016美国癌症协会
