Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Department of Surgery, Yamashita Hospital, Ichinomiya, Japan.
Br J Surg. 2017 Mar;104(4):426-433. doi: 10.1002/bjs.10452. Epub 2017 Jan 31.
Few studies have been conducted on patterns of recurrence after resection for distal cholangiocarcinoma (DCC). The aim of this study was to investigate the incidence and pattern of recurrence after resection of DCC, and to evaluate prognostic factors for time to recurrence and recurrence-free survival (RFS).
Patients who underwent pancreatoduodenectomy with curative intent for DCC between 2001 and 2010 at one of 30 hospitals in Japan were reviewed retrospectively, with special attention to recurrence patterns. The Cox proportional hazards model was used for multivariable analysis.
In the study interval, 389 patients underwent pancreatoduodenectomy for DCC with R0/M0 status. Recurrence developed in 213 patients (54·8 per cent). The estimated cumulative probability of recurrence was 54·3 per cent at 5 years. An initial locoregional recurrence occurred in 55 patients (14·1 per cent) and initial distant recurrence in 168 (43·2 per cent), most commonly in the liver. Isolated initial locoregional recurrence occurred in 45 patients (11·6 per cent). Independent prognostic factors for time to recurrence and RFS were perineural invasion (P = 0·001 and P = 0·009 respectively), pancreatic invasion (both P < 0·001) and lymph node metastasis (both P < 0·001). RFS worsened as the number of risk factors increased: the 5-year RFS rate was 70·6 per cent for patients without any risk factors, 50·3 per cent for patients with one factor, 31·8 per cent for those with two factors, and 13·4 per cent when three factors were present.
More than half of patients with DCC experienced recurrence after R0 resection, usually within 5 years. Perineural invasion, pancreatic invasion and positive nodal involvement are risk factors for recurrence.
针对远端胆管癌（DCC）切除术后复发模式，仅有少数研究进行了探讨。本研究旨在调查 DCC 根治性切除术后的复发发生率和模式，并评估与复发时间和无复发生存（RFS）相关的预后因素。
对 2001 年至 2010 年间日本 30 家医院中因 DCC 接受胰十二指肠切除术的患者进行了回顾性分析，特别关注复发模式。采用 Cox 比例风险模型进行多变量分析。
在研究期间，389 例患者因 DCC 行胰十二指肠切除术，均达到 R0/M0 状态。213 例（54.8%）患者发生了复发。5 年时估计的累积复发概率为 54.3%。55 例（14.1%）患者初始为局部复发，168 例（43.2%）患者初始为远处复发，最常见于肝脏。45 例（11.6%）患者孤立性初始局部复发。局部复发时间和 RFS 的独立预后因素包括神经侵犯（P=0.001 和 P=0.009）、胰腺侵犯（均 P<0.001）和淋巴结转移（均 P<0.001）。随着危险因素数量的增加，RFS 逐渐恶化：无任何危险因素患者的 5 年 RFS 率为 70.6%，有 1 个危险因素的患者为 50.3%，有 2 个危险因素的患者为 31.8%，有 3 个危险因素的患者为 13.4%。
超过一半的 DCC 患者在 R0 切除后复发，通常在 5 年内。神经侵犯、胰腺侵犯和淋巴结转移是复发的危险因素。
