肝内胆管癌病因对根治性切除术后复发及预后的影响：一项多机构研究
Implications of Intrahepatic Cholangiocarcinoma Etiology on Recurrence and Prognosis after Curative-Intent Resection: a Multi-Institutional Study.
作者信息
Zhang Xu-Feng, Chakedis Jeffery, Bagante Fabio, Beal Eliza W, Lv Yi, Weiss Matthew, Popescu Irinel, Marques Hugo P, Aldrighetti Luca, Maithel Shishir K, Pulitano Carlo, Bauer Todd W, Shen Feng, Poultsides George A, Soubrane Oliver, Martel Guillaume, Groot Koerkamp B, Guglielmi Alfredo, Itaru Endo, Pawlik Timothy M
机构信息
Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Department of Surgery, The Ohio State University, Wexner Medical Center, 395 W. 12th Avenue, Suite 670, Columbus, OH, USA.
出版信息
World J Surg. 2018 Mar;42(3):849-857. doi: 10.1007/s00268-017-4199-9.
BACKGROUND
We sought to investigate the prognosis of patients following curative-intent surgery for intrahepatic cholangiocarcinoma (ICC) stratified by hepatitis B (HBV-ICC), hepatolithiasis (Stone-ICC), and no identifiable cause (conventional ICC) etiologic subtype.
METHODS
986 patients with HBV-ICC (n = 201), stone-ICC (n = 103), and conventional ICC (n = 682) who underwent curative-intent resection were identified from a multi-institutional database. Propensity score matching (PSM) was used to mitigate residual bias.
RESULTS
HBV-ICC patients more often had cirrhosis, earlier stage tumors, a mass-forming lesion, well-to-moderate tumor differentiation, and an R0 resection versus stone-ICC or conventional ICC patients. Five-year recurrence-free survival among HBV-ICC and conventional ICC patients was 23.9 and 17.8%, respectively, versus a recurrence-free of only 8.3% among patients with stone-ICC. Similarly, 5-year overall survival among patients with stone-ICC was only 18.3% compared with 48.9 and 38.0% for patients with HBV-ICC and conventional ICC, respectively. On PSM, patients with stone-ICC group had equivalent long-term outcomes as HBV-ICC patients. In contrast, on PSM, stone-ICC patients had a median overall survival of only 18.0 months versus 44.0 months for patients with conventional ICC. Median overall survival after intrahepatic-only recurrence among patients who had stone-ICC (6.0 months) was worse than OS among HBV-ICC (13.0 months) or conventional ICC (12.0 months) (p = 0.006 and p = 0.082, respectively).
CONCLUSIONS
While HBV-ICC had a better prognosis on unadjusted analyses, these differences were mitigated on PSM suggesting no stage-for-stage differences in outcomes compared with stone-ICC or conventional ICC. In contrast, patients with stone-ICC had worse long-term outcomes. These data highlight the relative importance of ICC etiology relative to established clinicopathological factors in the prognosis of patients with ICC.
背景
我们试图研究肝内胆管癌（ICC）患者在接受根治性手术后的预后情况，并根据乙型肝炎（HBV-ICC）、肝内胆管结石（结石性ICC）和无明确病因（传统ICC）的病因亚型进行分层。
方法
从一个多机构数据库中识别出986例接受根治性切除的HBV-ICC患者（n = 201）、结石性ICC患者（n = 103）和传统ICC患者（n = 682）。采用倾向评分匹配（PSM）来减轻残余偏倚。
结果
与结石性ICC或传统ICC患者相比，HBV-ICC患者更常伴有肝硬化、肿瘤分期较早、肿块形成性病变、肿瘤分化良好至中等，以及R0切除。HBV-ICC和传统ICC患者的5年无复发生存率分别为23.9%和17.8%，而结石性ICC患者的无复发生存率仅为8.3%。同样，结石性ICC患者的5年总生存率仅为18.3%相比，HBV-ICC和传统ICC患者分别为48.9%和38.0%相比。在PSM分析中，结石性ICC组患者的长期预后与HBV-ICC患者相当。相比之下，在PSM分析中，结石性ICC患者的中位总生存期仅为18.0个月，而传统ICC患者为44.0个月。结石性ICC患者仅肝内复发后的中位总生存期（6.0个月）比HBV-ICC患者（13.0个月）或传统ICC患者（12.0个月）更差（p分别为0.006和0.082）。
结论
虽然在未调整分析中HBV-ICC的预后较好，但在PSM分析中这些差异得到缓解，这表明与结石性ICC或传统ICC相比，各分期的预后无差异。相比之下，结石性ICC患者的长期预后较差。这些数据突出了ICC病因相对于已确定的临床病理因素在ICC患者预后中的相对重要性。
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