Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Department of Radiation Oncology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
Ann Surg Oncol. 2022 Aug;29(8):5094-5102. doi: 10.1245/s10434-022-11762-3. Epub 2022 Apr 20.
T2 intrahepatic cholangiocarcinoma (ICC) is defined as a solitary tumors with vascular invasion or multifocal tumors including satellite lesions, multiple lesions, and intrahepatic metastases. This study aimed to evaluate the prognosis associated with multifocal tumors.
The National Cancer Database was queried from 2004 to 2017 for patients with non-metastatic ICC. The patients were grouped based on T2 staging, multifocality, and lymph node involvement.
The study enrolled and classified 4887 patients into clinical (c) stage groups as follows: 15.2% with solitary T2N0 (sT2N0) tumors, 21.3% with multifocal T2N0 (mT2N0) tumors, and 63.5% with node-positive (TxN1) disease. Patients with (c)sT2N0 tumors had higher rates of surgical resection than those with (c)mT2N0 or (c)TxN1 disease (33.5% vs 19.7% vs 15.0%; p < 0.01). Median overall survival (OS) was better for the patients with (c)sT2N0 tumors than for those with multifocal and node-positive disease (15.4 vs 10.4 vs 10.4 months; p < 0.01). On multivariate analysis, (c)sT2N0 tumors were associated with better OS than (c)mT2N0 tumors [hazard ratio (HR), 1.31; 95% confidence interval (CI), 1.17-1.46; p < 0.01] or (c)TxN1 disease (HR,1.41; 95% CI 1.28-1.56; p < 0.01). In a subset analysis based on pathologic (p) staging of patients who underwent surgical resection with regional lymphadenectomy, multivariate analysis demonstrated that (p)sT2N0 tumors were associated with better OS than (p)mT2N0 tumors (HR,1.40; 95% CI 1.03-1.92; p = 0.03) or (p)TxN1 disease (HR, 2.05; 95% CI 1.62-2.58; p < 0.01).
Multifocal T2N0 ICC is associated with poor OS and has a disparate prognosis compared with solitary T2N0 disease, even among patients who undergo resection. Future staging criteria should account for the poor outcomes associated with multifocal ICC.
T2 型肝内胆管癌（ICC）被定义为具有血管侵犯的单发肿瘤或包括卫星病灶、多发病灶和肝内转移灶在内的多灶性肿瘤。本研究旨在评估多灶性肿瘤相关的预后。
从 2004 年至 2017 年，国家癌症数据库（National Cancer Database）中检索非转移性 ICC 患者。根据 T2 分期、多灶性和淋巴结受累情况对患者进行分组。
本研究共纳入并将 4887 名患者分为临床（c）期组，如下：15.2%为单发 T2N0（sT2N0）肿瘤，21.3%为多灶 T2N0（mT2N0）肿瘤，63.5%为淋巴结阳性（TxN1）疾病。与 mT2N0 或 TxN1 疾病患者相比，sT2N0 肿瘤患者接受手术切除的比例更高（33.5%比 19.7%比 15.0%；p<0.01）。sT2N0 肿瘤患者的中位总生存期（OS）优于多灶性和淋巴结阳性疾病患者（15.4 比 10.4 比 10.4 个月；p<0.01）。多因素分析显示，与 mT2N0 肿瘤相比（c）sT2N0 肿瘤患者的 OS 更好[风险比（HR），1.31；95%置信区间（CI），1.17-1.46；p<0.01]或 TxN1 疾病（HR，1.41；95%CI，1.28-1.56；p<0.01）。在对接受区域淋巴结清扫术的手术切除患者进行的基于病理（p）分期的亚组分析中，多因素分析表明，与 mT2N0 肿瘤相比（p）sT2N0 肿瘤患者的 OS 更好（HR，1.40；95%CI，1.03-1.92；p=0.03）或（p）TxN1 疾病（HR，2.05；95%CI，1.62-2.58；p<0.01）。
多灶性 T2N0 ICC 与不良 OS 相关，与单发 T2N0 疾病相比，预后差异较大，即使在接受切除的患者中也是如此。未来的分期标准应考虑多灶性 ICC 相关的不良结局。
