Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Radiology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Abdom Radiol (NY). 2021 Sep;46(9):4159-4169. doi: 10.1007/s00261-021-03101-z. Epub 2021 Apr 30.
To predict poor overall survival (OS) and risk of residual tumor after surgery using MR imaging, clinical, and histopathological findings in perihilar cholangiocarcinoma.
196 patients with perihilar cholangiocarcinoma who underwent preoperative MRI and curative-intent surgery were retrospectively included. MRI findings were assessed by two radiologists. Clinical characteristics and histopathological results such as serum carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA 19-9), T and N stage, and resection status, were also investigated. Cox regression analysis and the Kaplan-Meier method were used to identify prognostic factors for OS. We further analyzed the correlation between MRI features and residual tumors using logistic regression analysis.
The median OS was 25.0 ± 26.6 months. T stage (hazard ratio [HR] 6.26, p = 0.014), N stage (HR 1.86, p = 0.002), CA-19-9 >37 U/mL (HR 2.06, p < 0.001), enlarged LN on MRI (HR 1.69, p = 0.006), and residual tumor (HR 1.52, p = 0.034) were important predictors of poor survival. The 5-year OS of the complete resection group (n = 107) was significantly better than that of the residual tumor group (n = 89) (35.5% vs. 18.8%, p = 0.002). Additionally, peritumoral fat stranding (odds ratio[OR] 2.09, p = 0.027), Bismuth type III/IV (OR 1.95, p = 0.022), and common bile duct (CBD) involvement (OR 2.3, p = 0.008) on MRI were important predictors of residual tumors in univariate analyses. However, absence of peritumoral fat stranding was a significant independent predictor for complete resection (OR 1.99, p = 0.048) and showed the highest sensitivity, at 79.8%.
MR imaging, clinical and histopathological results are useful for predicting poor survival after surgery for perihilar cholangiocarcinoma. Furthermore, MRI findings, including peritumoral fat stranding, CBD involvement, and Bismuth type, are important for the prediction of residual tumors.
利用磁共振成像（MRI）、临床和组织病理学检查结果，预测肝门部胆管癌患者的总生存期（OS）和术后残留肿瘤的风险。
回顾性纳入 196 例接受术前 MRI 和根治性手术的肝门部胆管癌患者。由两位放射科医生评估 MRI 结果。还调查了临床特征和组织病理学结果，如血清癌胚抗原（CEA）、碳水化合物抗原 19-9（CA 19-9）、T 期和 N 期、以及切除状态。采用 Cox 回归分析和 Kaplan-Meier 法确定 OS 的预后因素。我们还使用逻辑回归分析进一步分析了 MRI 特征与残留肿瘤之间的相关性。
中位 OS 为 25.0±26.6 个月。T 期（风险比 [HR] 6.26，p=0.014）、N 期（HR 1.86，p=0.002）、CA-19-9＞37 U/mL（HR 2.06，p＜0.001）、MRI 上增大的淋巴结（HR 1.69，p=0.006）和残留肿瘤（HR 1.52，p=0.034）是生存不良的重要预测因素。完全切除组（n=107）的 5 年 OS 明显优于残留肿瘤组（n=89）（35.5%比 18.8%，p=0.002）。此外，MRI 上的肿瘤周围脂肪条纹（比值比[OR] 2.09，p=0.027）、Bismuth Ⅲ/Ⅳ 型（OR 1.95，p=0.022）和胆总管（CBD）受累（OR 2.3，p=0.008）在单因素分析中是残留肿瘤的重要预测因素。然而，肿瘤周围无脂肪条纹是完全切除的显著独立预测因素（OR 1.99，p=0.048），其敏感性最高，为 79.8%。
MR 成像、临床和组织病理学结果可用于预测肝门部胆管癌患者手术后的生存情况。此外，包括肿瘤周围脂肪条纹、CBD 受累和 Bismuth 型在内的 MRI 表现对于残留肿瘤的预测很重要。
