van Keulen Anne-Marleen, Olthof Pim B, Cescon Matteo, Guglielmi Alfredo, Jarnagin William R, Nadalin Silvio, Pratschke Johann, Ratti Francesca, Troisi Roberto I, Groot Koerkamp Bas, Buettner Stefan, Erdmann Joris I
Erasmus Medical Center, Department of Surgery, 3015 GD Rotterdam, The Netherlands.
Department of Surgery, Amsterdam University Medical Centers, 1105 AZ Amsterdam, The Netherlands.
Cancers (Basel). 2021 Dec 13;13(24):6260. doi: 10.3390/cancers13246260.
Complete resection of perihilar cholangiocarcinoma (pCCA) is the only potentially curative treatment. Long-term survival data is rare and prognostic analyses are hindered by the rarity of the disease. This study aimed to determine the cure rate and to identify clinicopathological factors that may preclude cure. All consecutive resections for pathologically confirmed pCCA between 2000 and 2009 in 22 centers worldwide were included in a retrospective cohort study. Each center included its retrospective data series. A total of 460 patients were included with a median follow-up of 10 years for patients alive at last follow-up. Median overall survival (OS) was 29.9 months and 10-year OS was 12.8%. Twenty-nine (6%) patients reached 10-year OS. The observed cure rate was 5%. Factors that virtually precluded cure (i.e., below 1%) according to the mixture cure model included age above 70, Bismuth-Corlette type IV tumors, hepatic artery reconstruction, and positive resection margins. Cure was unlikely (i.e., below 3%) in patients with positive lymph nodes or poor tumor differentiation. These factors need to be considered in patient counseling and long-term follow-up after surgery.
肝门周围胆管癌（pCCA）的完整切除是唯一可能治愈的治疗方法。长期生存数据稀少，且该疾病的罕见性阻碍了预后分析。本研究旨在确定治愈率，并识别可能妨碍治愈的临床病理因素。一项回顾性队列研究纳入了2000年至2009年间全球22个中心所有经病理证实的pCCA连续切除病例。每个中心纳入其回顾性数据系列。共纳入460例患者，对最后随访时存活的患者中位随访10年。中位总生存期（OS）为29.9个月，10年总生存率为12.8%。29例（6%）患者达到10年总生存期。观察到的治愈率为5%。根据混合治愈模型，实际上排除治愈可能（即低于1%）的因素包括70岁以上、Bismuth-Corlette IV型肿瘤、肝动脉重建和切缘阳性。淋巴结阳性或肿瘤分化差的患者治愈可能性不大（即低于3%）。在患者咨询和术后长期随访中需要考虑这些因素。
