Department of Surgery, Erasmus MC University Medical Center, 's Gravendijkwal 230, PO Box 2040, 3000 CA, Rotterdam, Netherlands.
The Ohio State University Wexner Medical Center, Columbus, OH, USA.
J Gastrointest Surg. 2019 Nov;23(11):2239-2246. doi: 10.1007/s11605-019-04184-2. Epub 2019 Mar 18.
Multiple tumor foci of intrahepatic cholangiocarcinoma (ICC) are often considered a contra-indication for resection. We sought to define long-term outcomes after resection of ICC in patients with multiple foci.
Patients who underwent resection for ICC between 1990 and 2017 were identified from 12 major HPB centers. Outcomes of patients with solitary lesions, multiple lesions (ML), and oligometastases (OM) were compared. OM were defined as extrahepatic metastases spread to a single organ.
One thousand thirteen patients underwent resection of ICC. On final pathology, 185 patients (18.4%) had ML and 27 (2.7%) had OM. Median survival of patients with a solitary tumor was 43.2 months, while the median survival of patients with 2 tumors was 21.2 months; the median survival of patients with 3 or more tumors was 15.3 months (p < 0.001). Five-year survival was 43.3%, 28.0%, and 8.6%, respectively. The median survival of patients without OM was 37.8 months versus 14.9 months among patients with OM (p < 0.001); estimated 5-year survival was 39.3% and 10.6%, respectively. In multivariable analysis, the presence of two lesions was not an independent poor prognostic factor for OS (HR 1.19; 95%CI 0.90-1.57; p = 0.229). However, the presence of three or more tumors was an independent poor prognostic factor for OS (HR 1.97; 95%CI 1.48-2.64; p < 0.001).
Resection of multiple liver tumors for patients with ICC did not preclude 5-year survival: in particular, estimated 5-year OS for resection of two tumors was 28.0%.
多发肝内胆管细胞癌（ICC）病灶常被认为是切除的禁忌证。我们旨在明确多发病灶ICC 患者行切除术的长期预后。
从 12 个主要肝胆中心中确定了 1990 年至 2017 年间接受 ICC 切除术的患者。比较了单发肿瘤、多发病灶（ML）和寡转移（OM）患者的结局。OM 定义为肝外转移扩散至单一器官。
1013 例患者接受了 ICC 切除术。最终病理学显示，185 例（18.4%）患者为 ML，27 例（2.7%）为 OM。单发肿瘤患者的中位生存时间为 43.2 个月，而 2 个肿瘤患者的中位生存时间为 21.2 个月；3 个或更多肿瘤患者的中位生存时间为 15.3 个月（p<0.001）。5 年生存率分别为 43.3%、28.0%和 8.6%。无 OM 患者的中位生存时间为 37.8 个月，而 OM 患者的中位生存时间为 14.9 个月（p<0.001）；估计 5 年生存率分别为 39.3%和 10.6%。多变量分析显示，存在 2 个病灶不是 OS 的独立不良预后因素（HR 1.19；95%CI 0.90-1.57；p=0.229）。然而，存在 3 个或更多肿瘤是 OS 的独立不良预后因素（HR 1.97；95%CI 1.48-2.64；p<0.001）。
ICC 患者切除多个肝脏肿瘤不排除 5 年生存：特别是，切除 2 个肿瘤的估计 5 年 OS 为 28.0%。
