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
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.
J Surg Oncol. 2019 Jan;119(1):21-29. doi: 10.1002/jso.25305. Epub 2018 Nov 22.
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.
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).
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.
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.
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。
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。
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。
约五分之一接受切除的ICC患者发生MiVI。MiVI与肿瘤晚期特征及更高的肿瘤复发风险相关。
