肿瘤负荷决定肝内胆管癌切除患者的预后：一种指导术后辅助化疗的工具？
Tumor Burden Dictates Prognosis Among Patients Undergoing Resection of Intrahepatic Cholangiocarcinoma: A Tool to Guide Post-Resection Adjuvant Chemotherapy?
作者信息
Tsilimigras Diamantis I, Hyer J Madison, Paredes Anghela Z, Moris Dimitrios, Sahara Kota, Guglielmi Alfredo, Aldrighetti Luca, Weiss Matthew, Bauer Todd W, Alexandrescu Sorin, Poultsides George A, Maithel Shishir K, Marques Hugo P, Martel Guillaume, Pulitano Carlo, Shen Feng, Soubrane Olivier, Koerkamp Bas Groot, Endo Itaru, Sasaki Kazunari, Aucejo Federico, Zhang Xu-Feng, Pawlik Timothy M
机构信息
Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Department of Surgery, University of Verona, Verona, Italy.
出版信息
Ann Surg Oncol. 2021 Apr;28(4):1970-1978. doi: 10.1245/s10434-020-09393-7. Epub 2020 Dec 1.
INTRODUCTION
While tumor burden (TB) has been associated with outcomes among patients with hepatocellular carcinoma, the role of overall TB in intrahepatic cholangiocarcinoma (ICC) remains poorly defined.
METHODS
Patients undergoing curative-intent resection of ICC between 2000 and 2017 were identified from a multi-institutional database. The impact of TB on overall (OS) and disease-free survival (DFS) was evaluated in the multi-institutional database and validated externally.
RESULTS
Among 1101 patients who underwent curative-intent resection of ICC, 624 (56.7%) had low TB, 346 (31.4%) medium TB, and 131 (11.9%) high TB. OS incrementally worsened with higher TB (5-year OS; low TB: 48.3% vs medium TB: 29.8% vs high TB: 17.3%, p < 0.001). Similarly, patients with low TB had better DFS compared with medium and high TB patients (5-year DFS: 38.3% vs 18.7% vs 6.9%, p < 0.001). On multivariable analysis, TB was independently associated with OS (medium TB: HR = 1.40, 95% CI 1.14-1.71; high TB: HR = 1.89, 95% CI 1.46-2.45) and DFS (medium TB, HR = 1.61, 95% CI 1.33-1.96; high TB: HR = 2.03, 95% CI 1.56-2.64). Survival analysis revealed an excellent prognostic discrimination using the TB among the external validation cohort (3-year OS; low TB: 44.8%, medium TB: 29.3%; high TB: 23.3%, p = 0.03; 3-year DFS: low TB: 32.7%, medium TB: 10.7%; high TB: 0%, p < 0.001). While neoadjuvant chemotherapy was not associated with survival across the TB groups, receipt of adjuvant chemotherapy was associated with increased survival among patients with high TB (5-year OS: 24.4% vs 13.4%, p = 0.02).
CONCLUSION
Overall TB dictated prognosis among patients with resectable ICC. TB may be used as a tool to help guide post-resection treatment strategies.
引言
虽然肿瘤负荷（TB）已被证明与肝细胞癌患者的预后相关，但总体肿瘤负荷在肝内胆管癌（ICC）中的作用仍不明确。
方法
从一个多机构数据库中识别出2000年至2017年间接受根治性切除的ICC患者。在多机构数据库中评估肿瘤负荷对总生存期（OS）和无病生存期（DFS）的影响，并进行外部验证。
结果
在1101例接受根治性切除的ICC患者中，624例（56.7%）肿瘤负荷低，346例（31.4%）中等肿瘤负荷，131例（11.9%）高肿瘤负荷。随着肿瘤负荷增加，总生存期逐渐恶化（5年总生存期；低肿瘤负荷：48.3%，中等肿瘤负荷：29.8%，高肿瘤负荷：17.3%，p<0.001）。同样，与中等和高肿瘤负荷患者相比，低肿瘤负荷患者的无病生存期更好（5年无病生存期：38.3%，18.7%，6.9%，p<0.001）。多变量分析显示，肿瘤负荷与总生存期独立相关（中等肿瘤负荷：HR=1.40，95%CI 1.14-1.71；高肿瘤负荷：HR=1.89，95%CI 1.46-2.45）和无病生存期（中等肿瘤负荷，HR=1.61，95%CI 1.33-1.96；高肿瘤负荷：HR=2.03，95%CI 1.56-2.64）。生存分析显示，在外部验证队列中，使用肿瘤负荷进行预后判断效果良好（3年总生存期；低肿瘤负荷：44.8%，中等肿瘤负荷：29.3%；高肿瘤负荷：23.3%，p=0.03；3年无病生存期：低肿瘤负荷：32.7%，中等肿瘤负荷：10.7%；高肿瘤负荷：0%，p<0.001）。虽然新辅助化疗与各肿瘤负荷组的生存率无关，但辅助化疗与高肿瘤负荷患者的生存率提高相关（5年总生存期：24.4%对13.4%，p=0.02）。
结论
总体肿瘤负荷决定了可切除ICC患者的预后。肿瘤负荷可作为一种工具，帮助指导术后治疗策略。
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