Levy Nimrod Adatto, Kern Guy, Shepshelovich Daniel, Shibolet Oren, Hershkoviz Rami, Isakov Ofer
Internal Medicine "T", Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Gastroenterology and Liver Diseases, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
Oncotarget. 2020 Nov 24;11(47):4438-4447. doi: 10.18632/oncotarget.27820.
Intrahepatic cholangiocarcinoma (iCCA) is a biliary tract malignancy with rising incidence in recent decades. While the causative role of cirrhosis in the development of iCCA is well established, the role of cirrhosis as a prognostic factor in iCCA is debatable.
The study population consisted of 512 patients diagnosed with iCCA between 2004-2016 collected from the Surveillance, Epidemiology and End Results (SEER) database. The impact of fibrosis on overall and cancer-specific survival 12, 36 and 60 months following diagnosis, was evaluated in the entire cohort and in sub-groups stratified according to treatment approach and the American Joint Committee on Cancer (AJCC) tumor stage using a Cox proportional-hazards model.
After adjusting for age, sex, race, year of diagnosis, AJCC stage, and surgical treatment strategy, advanced fibrosis was associated with worse cancer-specific survival across follow up periods (HR 1.49 (1.13-1.96, = 0.005); HR 1.44 (1.14-1.83, = 0.002) and HR 1.45 (1.15-1.83, = 0.002) for 12, 36 and 60 months, respectively). Similar effects were observed for overall survival. Among patients that underwent surgical resection, advanced fibrosis was associated with worse overall survival and cancer-specific survival across follow up periods. Fibrosis was associated with worse overall and cancer-specific survival in patients with a later stage (III-IV) at diagnosis but this effect was not demonstrated in early stages.
Patients with iCCA and advanced liver fibrosis have an increased risk of both overall and cancer-specific mortality compared to patients with earlier stages of fibrosis.
肝内胆管癌（iCCA）是一种胆道恶性肿瘤，近几十年来发病率不断上升。虽然肝硬化在iCCA发生中的致病作用已得到充分证实，但肝硬化作为iCCA预后因素的作用仍存在争议。
研究人群包括2004年至2016年间从监测、流行病学和最终结果（SEER）数据库收集的512例诊断为iCCA的患者。使用Cox比例风险模型，在整个队列以及根据治疗方法和美国癌症联合委员会（AJCC）肿瘤分期分层的亚组中，评估诊断后12、36和60个月时纤维化对总生存期和癌症特异性生存期的影响。
在调整年龄、性别、种族、诊断年份、AJCC分期和手术治疗策略后，在整个随访期间，晚期纤维化与较差的癌症特异性生存期相关（12个月、36个月和60个月时的风险比分别为1.49（1.13 - 1.96，P = 0.005）；1.44（1.14 - 1.83，P = 0.002）和1.45（1.15 - 1.83，P = 0.002））。总生存期也观察到类似结果。在接受手术切除的患者中，晚期纤维化在整个随访期间与较差的总生存期和癌症特异性生存期相关。纤维化与诊断时处于晚期（III - IV期）患者的较差总生存期和癌症特异性生存期相关，但在早期阶段未观察到这种影响。
与纤维化早期阶段的患者相比，iCCA和晚期肝纤维化患者的总死亡率和癌症特异性死亡率风险均增加。
