Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Division of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Hepatobiliary Pancreat Dis Int. 2018 Apr;17(2):155-162. doi: 10.1016/j.hbpd.2018.03.003. Epub 2018 Mar 6.
Low resectability and poor survival outcome are common for hilar cholangiocarcinoma (HCCA), especially in advanced stages. The present study was to assess the clinical outcome of advanced HCCA, focusing on therapeutic modalities, survival analysis and prognostic assessment.
Clinical data of 176 advanced HCCA patients who had been treated in our hospital between January 2013 and December 2015 were analyzed retrospectively. Prognostic effects of clinicopathological factors were explored by univariate and multivariate analysis. Survival predictors were evaluated by the receiver operating characteristic (ROC) curve.
The 3-year overall survival rate was 13% for patients with advanced HCCA. Preoperative total bilirubin (P = 0.009), hepatic artery invasion (P = 0.014) and treatment modalities (P = 0.020) were independent prognostic factors on overall survival. A model combining these independent prognostic factors (area under ROC curve: 0.748; 95% CI: 0.678-0.811; sensitivity: 82.3%, specificity: 53.5%) was highly predictive of tumor death. After R0 resection, the 3-year overall survival was up to 38%. Preoperative total bilirubin was still an independent negative factor, but not for hepatic artery invasion.
Surgery is still the best treatment for advanced HCCA. Preoperative biliary drainage should be performed in highly-jaundiced patients to improve survival. Prediction of survival is improved significantly by a model that incorporates preoperative total bilirubin, hepatic artery invasion and treatment modalities.
肝门部胆管癌（HCCA）的可切除率低，生存结局差，尤其是在晚期。本研究旨在评估晚期 HCCA 的临床结局，重点关注治疗方式、生存分析和预后评估。
回顾性分析了 2013 年 1 月至 2015 年 12 月期间在我院治疗的 176 例晚期 HCCA 患者的临床资料。采用单因素和多因素分析探讨临床病理因素的预后作用。采用受试者工作特征（ROC）曲线评估生存预测因素。
晚期 HCCA 患者的 3 年总生存率为 13%。术前总胆红素（P=0.009）、肝动脉侵犯（P=0.014）和治疗方式（P=0.020）是总生存的独立预后因素。联合这些独立预后因素的模型（ROC 曲线下面积：0.748；95%CI：0.678-0.811；灵敏度：82.3%，特异性：53.5%）对肿瘤死亡具有高度预测性。RO 切除后，3 年总生存率高达 38%。术前总胆红素仍然是一个独立的负面因素，但肝动脉侵犯不是。
手术仍然是晚期 HCCA 的最佳治疗方法。对于高胆红素血症患者，术前应行胆道引流以提高生存率。通过包含术前总胆红素、肝动脉侵犯和治疗方式的模型，生存预测得到了显著改善。
