van Vugt Jeroen L A, Gaspersz Marcia P, Coelen Robert J S, Vugts Jaynee, Labeur Tim A, de Jonge Jeroen, Polak Wojciech G, Busch Olivier R C, Besselink Marc G, IJzermans Jan N M, Nio Chung Y, van Gulik Thomas M, Willemssen François E J A, 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). 2018 Jan;20(1):83-92. doi: 10.1016/j.hpb.2017.08.025. Epub 2017 Sep 25.
Although several classifications of perihilar cholangiocarcinoma (PHC) include vascular involvement, its prognostic value has not been investigated. Our aim was to assess the prognostic value of unilateral and main/bilateral involvement of the portal vein (PV) and hepatic artery (HA) on imaging in patients with PHC.
All patients with PHC between 2002 and 2014 were included regardless of stage or management. Vascular involvement was defined as apparent tumor contact of at least 180° to the PV or HA on imaging. Kaplan-Meier method with log-rank test was used to compare overall survival (OS) between groups. Cox regression was used for multivariable analysis.
In total, 674 patients were included with a median OS of 12.2 (95% CI 10.6-13.7) months. Patients with unilateral PV involvement had a median OS of 13.3 (11.0-15.7) months, compared with 14.7 (11.7-17.6) in patients without PV involvement (p = 0.12). Patients with main/bilateral PV involvement had an inferior median OS of 8.0 (5.4-10.7, p < 0.001) months. Median OS for patients with unilateral HA involvement was 10.6 (9.3-12.0) months compared with 16.9 (13.2-20.5) in patients without HA involvement (p < 0.001). Patients with main/bilateral HA involvement had an inferior median OS of 6.9 (3.3-10.5, p < 0.001). Independent poor prognostic factors included unilateral and main/bilateral HA involvement, but not PV involvement.
Both unilateral and main HA involvement are independent poor prognostic factors for OS in patients presenting with PHC, whereas PV involvement is not.
尽管肝门部胆管癌（PHC）的几种分类包括血管受累情况，但其预后价值尚未得到研究。我们的目的是评估门静脉（PV）和肝动脉（HA）单侧及主要/双侧受累情况在PHC患者影像学检查中的预后价值。
纳入2002年至2014年间所有PHC患者，无论其分期或治疗方式如何。血管受累定义为影像学检查显示肿瘤与PV或HA至少有180°的明显接触。采用Kaplan-Meier法和对数秩检验比较各组间的总生存期（OS）。采用Cox回归进行多变量分析。
共纳入674例患者，中位OS为12.2（95%CI 10.6 - 13.7）个月。PV单侧受累患者的中位OS为13.3（11.0 - 15.7）个月，而无PV受累患者为14.7（11.7 - 17.6）个月（p = 0.12）。PV主要/双侧受累患者的中位OS较差，为8.0（5.4 - 10.7，p < 0.001）个月。HA单侧受累患者的中位OS为10.6（9.3 - 12.0）个月，无HA受累患者为16.9（13.2 - 20.5）个月（p < 0.001）。HA主要/双侧受累患者的中位OS较差，为6.9（3.3 - 10.5，p < 0.001）。独立的不良预后因素包括HA单侧及主要/双侧受累，但不包括PV受累。
HA单侧及主要受累均是PHC患者OS的独立不良预后因素，而PV受累则不是。
