Suzuki Shuji, Shimoda Mitsugi, Shimazaki Jiro, Maruyama Tsunehiko, Oshiro Yukio, Nishida Kiyotaka, Kuroda Jun, Miyoshi Kenta, Koike Nobusada, Harada Nobuhiko
Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki 300-0395, Japan.
Department of Surgery, Hachioji Digestive Disease Hospital, Tokyo 192-0903, Japan.
Clin Exp Gastroenterol. 2019 Jun 6;12:255-262. doi: 10.2147/CEG.S207333. eCollection 2019.
Early recurrence of distal cholangiocarcinoma (DCC) may result in a poorer prognosis. This study aimed to evaluate the clinicopathological factors that predict survival and recurrence in patients with DCC. Fifty-five patients with DCC who underwent pancreaticoduodenectomy between 2005 and 2015 were studied retrospectively. The following clinicopathological parameters were analyzed as predictors of disease-free survival (DFS) and overall survival (OS): sex, age, body mass index, presence of biliary tract decompression, macroscopic type, histological type, tumor size, TNM classification, lymph node metastasis ratio, number of positive lymph nodes (PLNs), lymphatic invasion, venous invasion, perineural invasion, proximal bile duct margin, dissected margin, portal system invasion, arterial system invasion, stage, and residual tumor. Univariate analysis showed that contiguous extension of the primary tumor, PLN, lymphatic invasion, venous invasion, perineural invasion, and stage were significant prognostic factors for DFS and OS. Multivariate analysis revealed that PLN and lymphatic invasion were prognostic for DFS and OS (<0.001). Significant differences in OS and DFS were found in analyses stratified by PLN (0, 1, 2 vs ≥3) and lymphatic invasion (0 vs 1, 2, 3). Among the clinicopathological parameters analyzed, PLN and lymphatic invasion were confirmed as prognostic factors for DCC.
远端胆管癌（DCC）的早期复发可能导致预后较差。本研究旨在评估预测DCC患者生存和复发的临床病理因素。对2005年至2015年间接受胰十二指肠切除术的55例DCC患者进行回顾性研究。分析以下临床病理参数作为无病生存期（DFS）和总生存期（OS）的预测指标：性别、年龄、体重指数、胆道减压情况、大体类型、组织学类型、肿瘤大小、TNM分期、淋巴结转移率、阳性淋巴结数量（PLNs）、淋巴管侵犯、静脉侵犯、神经周围侵犯、近端胆管切缘、手术切缘、门静脉系统侵犯、动脉系统侵犯、分期和残留肿瘤。单因素分析显示，原发肿瘤的连续扩展、PLN、淋巴管侵犯、静脉侵犯、神经周围侵犯和分期是DFS和OS的重要预后因素。多因素分析显示，PLN和淋巴管侵犯对DFS和OS具有预后意义（<0.001）。按PLN（0、1、2与≥3）和淋巴管侵犯（0与1、2、3）分层分析发现，OS和DFS存在显著差异。在所分析的临床病理参数中，PLN和淋巴管侵犯被确认为DCC的预后因素。
