微血管侵犯对肝内胆管癌根治性切除术后临床结局的影响。

Impact of microvascular invasion on clinical outcomes after curative-intent resection for intrahepatic cholangiocarcinoma.

作者信息

Hu Liang-Shuo, Weiss Matthew, Popescu Irinel, Marques Hugo P, Aldrighetti Luca, Maithel Shishir K, Pulitano Carlo, Bauer Todd W, Shen Feng, Poultsides George A, Soubrane Oliver, Martel Guillaume, Koerkamp B Groot, Itaru Endo, Pawlik Timothy M

机构信息

Department of Hepatobiliary Surgery and Institute of Advanced Surgical Technology and Engineering, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.

Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland.

出版信息

J Surg Oncol. 2019 Jan;119(1):21-29. doi: 10.1002/jso.25305. Epub 2018 Nov 22.

DOI:10.1002/jso.25305

PMID:30466151

Abstract

BACKGROUND

Microvascular invasion (MiVI) is a histological feature of intrahepatic cholangiocarcinoma (ICC) that may be associated with biological behavior. We sought to investigate the impact of MiVI on long-term survival of patients undergoing curative-intent resection for ICC.

METHODS

A total of 1089 patients undergoing curative-intent resection for ICC were identified. Data on clinicopathological characteristics, disease-free survival (DFS), and overall survival (OS) were compared among patients with no vascular invasion (NoVI), MiVI, and macrovascular invasion (MaVI).

RESULTS

A total of 249 (22.9%) patients had MiVI, while 149 (13.7%) patients had MaVI (±MiVI). MiVI was associated with higher incidence of perineural, biliary and adjacent organ invasion, and satellite lesions (all P < 0.01). On multivariable analysis, MiVI was an independent risk factor of DFS (hazard ratios [HR] 1.5; 95%confidence intervals [CI], 1.3-1.9; P < 0.001), but not OS (HR 1.1; 95%CI, 0.9-1.3; P = 0.379). While MiVI and MaVI patients had similar DFS (median, MiVI 14.0 vs MaVI 12.0 months, HR 0.9; 95%CI, 0.7-1.2; P = 0.377), OS was better among MiVI patients (median, MiVI 39.0 vs MaVI 21.0 months, HR 0.7; 95%CI, 0.5-0.8; P = 0.002). Whereas nodal metastasis, R1 margin, and postoperative morbidity were associated with early death (≤18 months) among patients with MiVI, only nodal metastasis was associated with late (>18 months) prognosis.

CONCLUSIONS

Roughly 1 out of 5 patients with resected ICC had MiVI. MiVI was associated with advanced tumor characteristics and a higher risk of tumor recurrence.

摘要

背景

微血管侵犯（MiVI）是肝内胆管癌（ICC）的一种组织学特征，可能与生物学行为相关。我们旨在研究MiVI对接受根治性切除的ICC患者长期生存的影响。

方法

共纳入1089例接受根治性切除的ICC患者。比较无血管侵犯（NoVI）、MiVI和大血管侵犯（MaVI）患者的临床病理特征、无病生存期（DFS）和总生存期（OS）数据。

结果

共有249例（22.9%）患者发生MiVI，149例（13.7%）患者发生MaVI（±MiVI）。MiVI与神经周围、胆管及邻近器官侵犯以及卫星灶的发生率较高相关（均P<0.01）。多变量分析显示，MiVI是DFS的独立危险因素（风险比[HR]1.5；95%置信区间[CI]，1.3 - 1.9；P<0.001），但不是OS的独立危险因素（HR 1.1；95%CI，0.9 - 1.3；P = 0.379）。虽然MiVI和MaVI患者的DFS相似（中位数，MiVI为14.0个月，MaVI为12.0个月，HR 0.9；95%CI，0.7 - 1.2；P = 0.377），但MiVI患者的OS更好（中位数，MiVI为39.0个月，MaVI为21.0个月，HR 0.7；95%CI，0.5 - 0.8；P = 0.002）。在MiVI患者中，淋巴结转移、R1切缘和术后并发症与早期死亡（≤18个月）相关，只有淋巴结转移与晚期（>18个月）预后相关。