Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
Division of Surgical Oncology, Health Services Management and Policy, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
Ann Surg Oncol. 2021 Aug;28(8):4205-4213. doi: 10.1245/s10434-021-09811-4. Epub 2021 Mar 11.
Although multidisciplinary treatments including the use of adjuvant therapy (AT) have been adopted for biliary tract cancers, patients with distal cholangiocarcinoma (DCC) can still experience recurrence. We sought to characterize the incidence and predictors of early recurrence (ER) that occurred within 12 months following surgery for DCC.
Patients who underwent resection for DCC between 2000 and 2015 were identified from the US multi-institutional database. Cox regression analysis was used to identify clinicopathological factors to develop an ER risk score, and the predictive model was validated in an external dataset.
Among 245 patients included in the analysis, 67 patients (27.3%) developed ER. No difference was noted in ER rates between patients who did and did not receive AT (28.7% vs. 25.0%, p = 0.55). Multivariable analysis revealed that neutrophil-to-lymphocyte ratio (NLR), peak total bilirubin (T-Bil), major vascular resection (MVR), lymphovascular invasion, and R1 surgical margin status were associated with a higher ER risk. A DIstal Cholangiocarcinoma Early Recurrence Score was developed according to each factor available prior to surgery [NLR > 9.0 (2 points); peak T-bil > 1.5 mg/dL (1 points); MVR (2 points)]. Cumulative ER rates incrementally increased among patients who were low (0 points; 10.6%), intermediate (1-2 points; 26.8%), or high (3-5 points; 57.6%) risk (p < 0.001) in the training dataset, as well as in the validation dataset [low (0 points); 3.4%, intermediate (1-2 points); 32.7%, or high risk (3-5 points); 55.6% (p < 0.001)].
Among patients undergoing resection for DCC, 1 in 4 patients experienced an ER. Alternative treatment strategies such as neoadjuvant chemotherapy may be considered especially among individuals deemed to be at high risk for ER.
尽管采用了包括辅助治疗（AT）在内的多学科治疗方法，但胆道癌患者仍可能出现复发。我们旨在描述接受远端胆管癌（DCC）手术后 12 个月内发生的早期复发（ER）的发生率和预测因素。
从美国多机构数据库中确定了 2000 年至 2015 年间接受 DCC 切除术的患者。使用 Cox 回归分析确定临床病理因素以建立 ER 风险评分，并在外部数据集进行验证。
在纳入分析的 245 名患者中，有 67 名患者（27.3%）发生 ER。接受和未接受 AT 的患者 ER 发生率无差异（28.7%比 25.0%，p=0.55）。多变量分析显示，中性粒细胞与淋巴细胞比值（NLR）、总胆红素峰值（T-Bil）、主要血管切除（MVR）、血管淋巴管侵犯和 R1 手术切缘状态与更高的 ER 风险相关。根据术前可获得的每个因素制定了 Distal Cholangiocarcinoma Early Recurrence Score [NLR＞9.0（2 分）；峰值 T-bil＞1.5mg/dL（1 分）；MVR（2 分）]。在训练数据集中，低风险（0 分；10.6%）、中风险（1-2 分；26.8%）或高风险（3-5 分；57.6%）患者的累积 ER 率逐渐增加（p＜0.001），在验证数据集也是如此[低风险（0 分；3.4%）、中风险（1-2 分；32.7%）或高风险（3-5 分；55.6%）（p＜0.001）]。
在接受 DCC 切除术的患者中，1/4 的患者发生 ER。对于被认为 ER 风险较高的患者，可能需要考虑替代治疗策略，例如新辅助化疗。
