Tang Zengwei, Yang Yuan, Zhao Zhonghong, Wei Kongyuan, Meng Wenbo, Li Xun
The First Clinical Medical School of Lanzhou University Department of Special Minimally Invasive Surgery, The First Hospital of Lanzhou University, Lanzhou People's Hospital of Zhengning County, Qingyang The Second Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.
Medicine (Baltimore). 2018 Aug;97(34):e11999. doi: 10.1097/MD.0000000000011999.
The refinement in surgical techniques combined with the preoperative management has improved the resectability rate of perihilar cholangiocarcinoma (pCCA). However, the prognosis of pCCA with curative resection is still dismal. This meta-analysis was performed to investigate the prognostic clinicopathological factors in resectable pCCA.PubMed, the Cochran Library, ScienceDirect, and Web of Science were searched systematically to identify reports focusing on studying the prognostic clinicopathological factors in resectable pCCA. The hazard ratios (HRs) and its 95% confidence interval (95%CI) from the identified studies using Cox proportional hazard regression model were extracted for overall survival (OS), disease-specific survival (DSS), and disease-free survival (DFS) analysis.Three prospective and 35 retrospective cohort studies including 5681 resectable pCCA were included in the pooled analysis. Among more than 20 clinicopathological factors associated with negative survival of pCCA, only 6 were included in quantitative analysis which showed that lymph node involvement was associated with a reduced OS (HR = 2.04; 95%CI: 2.10-2.62), DSS (HR = 1.80; 95%CI: 1.39-2.34), DFS (HR = 4.38; 95%CI: 1.89-10.14), negative resection margin (HR = 2.04; 95%CI:1.73-2.41), operative transfusion (HR = 1.82; 95%CI: 1.06-3.11), and T3 or T4-stage (HR = 2.04; 95%CI: 2.04-2.53) were poor prognostic factors of OS, and poor or moderate differentiation was also an adverse prognostic factor of OS (HR = 2.71; 95%CI: 1.80-4.07) and DSS (HR = 1.74; 95%CI: 1.25-2.44). The overall median resectability rate (95CI%), R0 resection (95CI%), and 5-year OS (95CI%) in Eastern and Western countries were 74.9 (66.4-78.4) % and 41.3 (32.6-80.8) %, 70.7 (65.6-80.8) % and 75.9 (64.0-80.4) %, and 33.0 (29.7-39.7) % and 25.5 (20.0-31.6) %, respectively.Negative resection margin, lymph node involvement, poor or moderate differentiation grade was identified as the negative predictor factors of resectable pCCA. Operative transfusion and T3/T4 stage were also associated with a reduced survival of resectable pCCA.
手术技术的改进与术前管理相结合，提高了肝门部胆管癌（pCCA）的可切除率。然而，根治性切除的pCCA患者预后仍然很差。本荟萃分析旨在研究可切除pCCA的预后临床病理因素。
系统检索了PubMed、Cochrane图书馆、ScienceDirect和Web of Science，以确定专注于研究可切除pCCA预后临床病理因素的报告。使用Cox比例风险回归模型，从纳入研究中提取风险比（HRs）及其95%置信区间（95%CI），用于总生存期（OS）、疾病特异性生存期（DSS）和无病生存期（DFS）分析。
汇总分析纳入了3项前瞻性和35项回顾性队列研究，共5681例可切除pCCA患者。在与pCCA生存不良相关的20多个临床病理因素中，只有6个因素纳入了定量分析，结果显示，淋巴结转移与OS降低相关（HR = 2.04；95%CI：2.10 - 2.62）、DSS降低相关（HR = 1.80；95%CI：1.39 - 2.34）、DFS降低相关（HR = 4.38；95%CI：1.89 - 10.14），切缘阴性（HR = 2.04；95%CI：1.73 - 2.41）、术中输血（HR = 1.82；95%CI：1.06 - 3.11）以及T3或T4期（HR = 2.04；95%CI：2.04 - 2.53）是OS的不良预后因素，低分化或中分化也是OS（HR = 2.71；95%CI：1.80 - 4.07）和DSS（HR = 1.74；95%CI：1.25 - 2.44）的不良预后因素。东西方国家的总体中位可切除率（95CI%）、R0切除率（95CI%）和5年OS率（95CI%）分别为74.9（66.4 - 78.4）%和41.3（（32.6 - 80.8）%、70.7（65.6 - 80.8）%和75.9（64.0 - 80.4）%、33.0（29.7 - 39.7）%和25.5（20.0 - 31.6）%。
切缘阴性、淋巴结转移、低分化或中分化程度被确定为可切除pCCA的阴性预测因素。术中输血和T3/T4期也与可切除pCCA的生存率降低相关。
