Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Department of Abdominal Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Surg Oncol. 2022 Mar;40:101696. doi: 10.1016/j.suronc.2021.101696. Epub 2021 Dec 31.
In patients undergoing resection of intrahepatic cholangiocarcinoma (ICC), hypervascularity during the arterial phase of contrast-enhanced computed tomography (CT) is associated with better prognosis than hypovascularity. However, the prognostic implications of arterial enhancement pattern in patients with unresectable ICC are unknown. We assessed the prognostic implications of arterial enhancement pattern in patients with resectable and unresectable ICC.
Consecutive patients who underwent surgery or gemcitabine-plus-cisplatin chemotherapy for ICC during 2003-2015 and CT with dynamic enhancement for diagnosis were included. After review by 2 radiologists, tumors were categorized according to the percentage of the tumor exhibiting arterial enhancement as hypervascular (>50% of tumor exhibiting enhancement), peripherally enhancing (10%-50%), and hypovascular (<10%). In each cohort (surgical and medical), overall survival (OS) curves were generated using the Kaplan-Meier method, and differences between curves were evaluated with Cox analysis.
The study included 56 patients treated surgically and 89 patients with unresectable ICC. Mean (standard deviation) tumor density in the hypervascular, peripherally enhancing, and hypovascular groups was 119.3 (45.2) Hounsfield units (HU), 72.1 (15.9) HU, and 59.9 (14.4) HU, respectively, in the surgical cohort and 93.6 (17.5) HU, 66.6 (16.2) HU, and 48.7 (14.3) HU, respectively, in the medical cohort. In both cohorts, the 5-year OS rate was significantly higher in the hypervascular group than in the hypovascular group (surgical, 67.6% vs 22.5%, P = .038; medical, 15.4% vs 0%, P = .030). In both cohorts, a Cox proportional hazards model analysis showed that hypervascularity was significantly associated with better OS.
Hypervascularity during the arterial CT phase is a prognostic biomarker in patients undergoing ICC resection and patients with unresectable ICC.
在接受肝内胆管癌（ICC）切除术的患者中，与低血管性相比，增强 CT 动脉期的高血管性与更好的预后相关。然而，不可切除的 ICC 患者的动脉增强模式的预后意义尚不清楚。我们评估了可切除和不可切除 ICC 患者的动脉增强模式的预后意义。
纳入 2003-2015 年期间因 ICC 接受手术或吉西他滨联合顺铂化疗且 CT 增强扫描用于诊断的连续患者。由 2 名放射科医生审查后，根据肿瘤动脉增强百分比将肿瘤分为高血管性（>50%的肿瘤增强）、外周增强（10%-50%）和低血管性（<10%）。在每个队列（手术和药物）中，使用 Kaplan-Meier 法生成总生存期（OS）曲线，并使用 Cox 分析评估曲线之间的差异。
该研究纳入了 56 例手术治疗和 89 例不可切除 ICC 患者。手术组高血管性、外周增强和低血管性肿瘤的平均（标准差）肿瘤密度分别为 119.3（45.2）HU、72.1（15.9）HU 和 59.9（14.4）HU，药物组分别为 93.6（17.5）HU、66.6（16.2）HU 和 48.7（14.3）HU。在两个队列中，高血管性组的 5 年 OS 率均明显高于低血管性组（手术组：67.6%比 22.5%，P=.038；药物组：15.4%比 0%，P=.030）。在两个队列中，Cox 比例风险模型分析显示高血管性与更好的 OS 显著相关。
在接受 ICC 切除术和不可切除 ICC 患者中，动脉 CT 期的高血管性是一个预后生物标志物。
