Gaspersz Marcia P, Buettner Stefan, van Vugt Jeroen L A, Roos Eva, Coelen Robert J S, Vugts Jaynee, Belt Eric J, de Jonge Jeroen, Polak Wojciech G, Willemssen François E J A, van Gulik Thomas M, IJzermans Jan N M, Groot Koerkamp Bas
Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
HPB (Oxford). 2017 Nov;19(11):966-971. doi: 10.1016/j.hpb.2017.07.004. Epub 2017 Jul 25.
Conditional survival is the life expectancy from a point in time for a patient who has survived a specific period after presentation. The aim of the study was to estimate conditional survival for patients with unresectable perihilar cholangiocarcinoma.
Patients with unresectable perihilar cholangiocarcinoma from two academic hospitals in the Netherlands between 2002 and 2012 were assessed. A multivariable Cox proportional hazards analysis was performed to identify risk factors associated with overall survival. Survival was estimated using the Kaplan-Meier method to evaluate factors associated with overall survival.
In total, 572 patients were included. Overall survival was 42% at one year and 6% at three years. The conditional chance of surviving three years was 15% at 1 year and increased to 38% at 2 years. Independent poor prognostic factors for overall survival were age ≥65 years, tumor size >3 cm on imaging, bilirubin levels (>250 μmol/L), CA19-9 level at presentation (>1000 U/ml), and suspected distant metastases on imaging. The conditional survival of patients with and without these prognostic factors was comparable after patients survived the first two or more years.
The conditional chance of surviving for patients with unresectable perihilar cholangiocarcinoma increases with time. Poor prognostic factors become less relevant once patients have survived two years.
条件生存是指患者在出现症状后存活特定时间段后的预期寿命。本研究的目的是估计不可切除的肝门部胆管癌患者的条件生存情况。
对2002年至2012年期间荷兰两家学术医院的不可切除肝门部胆管癌患者进行评估。进行多变量Cox比例风险分析以确定与总生存相关的危险因素。使用Kaplan-Meier方法估计生存情况以评估与总生存相关的因素。
共纳入572例患者。1年时总生存率为42%，3年时为6%。1年时生存3年的条件概率为15%，2年时增至38%。总生存的独立不良预后因素为年龄≥65岁、影像学检查肿瘤大小>3 cm、胆红素水平（>250 μmol/L）、初诊时CA19-9水平（>1000 U/ml）以及影像学检查怀疑有远处转移。在患者存活两年或更长时间后，有和没有这些预后因素的患者的条件生存情况相当。
不可切除的肝门部胆管癌患者的条件生存概率随时间增加。一旦患者存活两年，不良预后因素的相关性就会降低。
