Hepato-Pancreato-Biliary Surgery and Liver transplantation, Pôle des Pathologies Digestives, Hépatiques et de la Transplantation, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1, Avenue Molière, 67098, Strasbourg, France.
Department of Pathology, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
J Gastrointest Surg. 2019 Sep;23(9):1801-1809. doi: 10.1007/s11605-018-4052-y. Epub 2018 Nov 26.
The prognostic value of tumor multinodularity in intrahepatic cholangiocarcinoma (ICC) remains debated. We aimed to evaluate the impact of tumor multinodularity according to the presence and distribution of multiples ICC's nodules.
A retrospective review of a prospectively maintained database of patients undergoing resection for ICC from January 1995 to September 2017 was performed. Prognostic factors for survival were assessed by multivariate Cox analysis. Tumoral nodules were defined according to their number (single and multiple) and localization (satellites and contralateral).
Out of 120 selected patients, 64 (53%) had single and 56 (47%) had multiple lesions. Multiple lesions included tumors with satellites (n = 40; 71.5%) and tumors with contralateral lesions (n = 16; 28.5%). Patients with multiple tumors had significantly larger mean main lesion size (p = 0.02), required a higher rate of perioperative transfusion (p = 0.04), had a greater rate of lymph node involvement (p < 0.0001), vascular invasion (p = 0.04), and poor differentiation (p = 0.04) than single tumors. Patients with single tumors experienced a 5-year survival significantly longer (40%) than patients with multiple tumors (14%; p = 0.004). Patients having tumors with satellites had inferior median overall survival and 5-year survival rates (20 months, 7%) compared with patients with contralateral tumors (33.6 months, 29%) (p = 0.09). Multivariable analysis identified tumor multinodularity, morbidity, tumor size < 5 cm, poor differentiation, and lymph node involvement as independent prognostic factors for overall survival.
Tumor multinodularity represents an independent risk factor for survival in ICCs and identifies a category of patients in need of more effective perioperative treatment.
肿瘤多结节性在肝内胆管细胞癌（ICC）中的预后价值仍存在争议。我们旨在根据多个 ICC 结节的存在和分布来评估肿瘤多结节性的影响。
对 1995 年 1 月至 2017 年 9 月期间接受 ICC 切除术的患者前瞻性维护数据库进行了回顾性分析。通过多变量 Cox 分析评估生存的预后因素。肿瘤结节根据其数量（单发和多发）和定位（卫星灶和对侧）进行定义。
在 120 名入选患者中，64 名（53%）为单发，56 名（47%）为多发。多发病变包括有卫星灶的肿瘤（n=40；71.5%）和有对侧病变的肿瘤（n=16；28.5%）。多发肿瘤的患者主病灶平均大小明显更大（p=0.02），需要更高的围手术期输血率（p=0.04），淋巴结受累率更高（p<0.0001）、血管侵犯（p=0.04）和低分化（p=0.04），与单发肿瘤相比。单发肿瘤患者的 5 年生存率显著更高（40%），而多发肿瘤患者的 5 年生存率（14%；p=0.004）。有卫星灶的肿瘤患者的中位总生存期和 5 年生存率（20 个月，7%）均低于有对侧肿瘤的患者（33.6 个月，29%）（p=0.09）。多变量分析确定肿瘤多结节性、发病率、肿瘤大小<5cm、低分化和淋巴结受累是总生存期的独立预后因素。
肿瘤多结节性是 ICC 生存的独立危险因素，可识别出需要更有效的围手术期治疗的患者群体。
