Jesper Daniel, Heyn Sabrina G, Schellhaas Barbara, Pfeifer Lukas, Goertz Ruediger S, Zopf Steffen, Neurath Markus F, Strobel Deike
Department of Internal Medicine 1, Erlangen University Hospital, FAU University of Erlangen-Nürnberg, Erlangen, Germany.
Eur J Gastroenterol Hepatol. 2018 May;30(5):552-556. doi: 10.1097/MEG.0000000000001036.
The incidence of intrahepatic cholangiocarcinoma (iCCA) has been increasing over the past few decades. Liver cirrhosis is an independent risk factor for the development of iCCA. This study aimed to examine the prognostic impact of liver cirrhosis and patient condition on the treatment of iCCA.
We retrospectively analyzed the cases of 156 patients diagnosed with iCCA between 1990 and 2014 in our center. Patients were divided into subgroups depending on the presence and severity of liver cirrhosis and the type of treatment. Clinical data, patient characteristics, and overall survival were compared between these groups.
Forty-seven (30%) of 156 patients had liver cirrhosis, predominantly with Child-Pugh scores A (n=27) and B (n=12). The median survival differed between patients receiving tumor resection (34 months), chemotherapy (10 months), and best supportive care (2 months). An Eastern Cooperative Oncology Group Performance Status score more than 1 was a predictor of poor survival in all patients (P<0.001), independent of the presence of cirrhosis. Resection could be performed less frequently in cirrhotic patients (6 vs. 31 patients; P=0.04). If resection was performed, the presence of cirrhosis A/B did not influence survival. Cirrhosis A/B did not influence the outcome in patients receiving chemotherapy either. In cirrhotic patients receiving chemotherapy, cancer antigen 19-9 levels above 129 U/ml were associated with a significantly shorter survival (22.5 vs. 3 months, P=0.0003).
The presence of liver cirrhosis in iCCA has been underestimated. There was no difference in survival between noncirrhotic patients and patients with compensated cirrhosis. Patients' general condition seems to be of more prognostic value in the treatment of iCCA than the presence of cirrhosis. Therefore, the presence of cirrhosis A/B should not prevent patients with a good Eastern Cooperative Oncology Group Performance Status score from receiving tumor resection or chemotherapy.
在过去几十年中，肝内胆管癌（iCCA）的发病率一直在上升。肝硬化是iCCA发生的一个独立危险因素。本研究旨在探讨肝硬化和患者状况对iCCA治疗的预后影响。
我们回顾性分析了1990年至2014年在本中心诊断为iCCA的156例患者的病例。根据肝硬化的存在情况和严重程度以及治疗类型将患者分为亚组。比较这些组之间的临床数据、患者特征和总生存期。
156例患者中有47例（30%）患有肝硬化，主要为Child-Pugh评分A（n = 27）和B（n = 12）。接受肿瘤切除的患者（34个月）、化疗的患者（10个月）和最佳支持治疗的患者（2个月）的中位生存期不同。东部肿瘤协作组体能状态评分大于1是所有患者生存不良的一个预测因素（P < 0.001），与肝硬化的存在无关。肝硬化患者进行切除的频率较低（6例对31例；P = 0.04）。如果进行了切除，A/B级肝硬化的存在不影响生存期。A/B级肝硬化对接受化疗的患者的结局也没有影响。在接受化疗的肝硬化患者中，癌抗原19-9水平高于129 U/ml与生存期显著缩短相关（22.5个月对3个月，P = 0.0003）。
iCCA中肝硬化的存在一直被低估。非肝硬化患者和代偿期肝硬化患者的生存期没有差异。在iCCA的治疗中，患者的一般状况似乎比肝硬化的存在更具有预后价值。因此，A/B级肝硬化的存在不应阻止东部肿瘤协作组体能状态评分良好的患者接受肿瘤切除或化疗。
