Ito Yasuhiro, Abe Yuta, Egawa Tomohisa, Kitago Minoru, Itano Osamu, Kitagawa Yuko
Department of Surgery, Saiseikai Yokohamashi Tobu Hospital, 3-6-1 Shimosueyoshi, Tsurumi-ku, Yokohama-shi, Kanagawa 230-0012, Japan.
Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.
Gastroenterol Res Pract. 2018 Apr 3;2018:6431254. doi: 10.1155/2018/6431254. eCollection 2018.
To determine the factors associated with early recurrence in patients with distal cholangiocarcinoma after pancreaticoduodenectomy (PD).
Sixty-one patients with distal cholangiocarcinoma were enrolled. The clinical data and histopathological findings were collected retrospectively.
Patients were divided into two groups as follows: 16 patients (26%) with early recurrence and 45 patients (74%) with late recurrence or no recurrence. In a univariate analysis, lymph node metastases ( = 0.0016), lymphatic invasion ( < 0.0001), pancreatic invasion ( = 0.0006), and perineural invasion ( = 0.0004) were significantly different between the two groups. In a multivariate analysis, a higher incidence of lymphatic invasion was the only independent risk factor for early recurrence (odds ratio: 5.772, 95% confidence interval: 1.123-29.682, = 0.036). Moreover, the disease-free survival and overall survival of patients with a higher incidence of lymphatic invasion were significantly worse compared with those of patients with a lower incidence of lymphatic invasion ( < 0.001).
Our study showed that a higher incidence of lymphatic invasion was a significant predictor of early recurrence in patients with distal cholangiocarcinoma. Therefore, lymphatic invasion might be useful in determining the optimal adjuvant therapy in the early postoperative stage for distal cholangiocarcinoma.
确定胰十二指肠切除术（PD）后远端胆管癌患者早期复发的相关因素。
纳入61例远端胆管癌患者。回顾性收集临床资料和组织病理学检查结果。
患者分为两组：16例（26%）早期复发，45例（74%）晚期复发或未复发。单因素分析显示，两组之间淋巴结转移（P = 0.0016）、淋巴管侵犯（P < 0.0001）、胰腺侵犯（P = 0.0006）和神经周围侵犯（P = 0.0004）存在显著差异。多因素分析显示，淋巴管侵犯发生率较高是早期复发的唯一独立危险因素（比值比：5.772，95%置信区间：1.123 - 29.682，P = 0.036）。此外，淋巴管侵犯发生率较高的患者无病生存期和总生存期显著低于淋巴管侵犯发生率较低的患者（P < 0.001）。
我们的研究表明，淋巴管侵犯发生率较高是远端胆管癌患者早期复发的重要预测因素。因此，淋巴管侵犯可能有助于确定远端胆管癌术后早期的最佳辅助治疗方案。
