Kinzler Maximilian N, Klasen Christina, Schulze Falko, Herrmann Eva, Schnitzbauer Andreas A, Trojan Jörg, Zeuzem Stefan, Wild Peter J, Walter Dirk
Department of Internal Medicine I, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany.
Dr. Senckenberg Institute of Pathology, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany.
J Clin Med. 2022 Apr 6;11(7):2057. doi: 10.3390/jcm11072057.
Intrahepatic cholangiocarcinoma (iCCA) is the most frequent subtype of cholangiocarcinoma (CCA), and the incidence has globally increased in recent years. In contrast to surgically treated iCCA, data on the impact of fibrosis on survival in patients undergoing palliative chemotherapy are missing. We retrospectively analyzed the cases of 70 patients diagnosed with iCCA between 2007 and 2020 in our tertiary hospital. Histopathological assessment of fibrosis was performed by an expert hepatobiliary pathologist. Additionally, the fibrosis-4 score (FIB-4) was calculated as a non-invasive surrogate marker for liver fibrosis. For overall survival (OS) and progression-free survival (PFS), Kaplan-Meier curves and Cox-regression analyses were performed. Subgroup analyses revealed a median OS of 21 months (95% CI = 16.7-25.2 months) and 16 months (95% CI = 7.6-24.4 months) for low and high fibrosis, respectively ( 0.152). In non-cirrhotic patients, the median OS was 21.8 months (95% CI = 17.1-26.4 months), compared with 9.5 months (95% CI = 4.6-14.3 months) in cirrhotic patients ( 0.007). In conclusion, patients with iCCA and cirrhosis receiving palliative chemotherapy have decreased OS rates, while fibrosis has no significant impact on OS or PFS. These patients should not be prevented from state-of-the-art first-line chemotherapy.
肝内胆管癌（iCCA）是胆管癌（CCA）最常见的亚型，近年来全球发病率呈上升趋势。与接受手术治疗的iCCA不同，关于纤维化对接受姑息化疗患者生存影响的数据尚缺失。我们回顾性分析了2007年至2020年期间在我院确诊为iCCA的70例患者的病例。由肝胆病理专家进行纤维化的组织病理学评估。此外，计算纤维化-4评分（FIB-4）作为肝纤维化的非侵入性替代指标。对于总生存期（OS）和无进展生存期（PFS），进行了Kaplan-Meier曲线分析和Cox回归分析。亚组分析显示，低纤维化和高纤维化患者的中位OS分别为21个月（95%CI = 16.7-25.2个月）和16个月（95%CI = 7.6-24.4个月）（P = 0.152）。在非肝硬化患者中，中位OS为21.8个月（95%CI = 17.1-26.4个月），而肝硬化患者为9.5个月（95%CI = 4.6-14.3个月）（P = 0.007）。总之，接受姑息化疗的iCCA合并肝硬化患者的OS率降低，而纤维化对OS或PFS无显著影响。不应阻止这些患者接受一线标准化疗。
