Nooijen Lynn E, Banales Jesus M, de Boer Marieke T, Braconi Chiara, Folseraas Trine, Forner Alejandro, Holowko Waclaw, Hoogwater Frederik J H, Klümpen Heinz-Josef, Groot Koerkamp Bas, Lamarca Angela, La Casta Adelaida, López-López Flora, Izquierdo-Sánchez Laura, Scheiter Alexander, Utpatel Kirsten, Swijnenburg Rutger-Jan, Kazemier Geert, Erdmann Joris I
Department of Surgery, Amsterdam UMC-Location Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands.
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, 1081 HV Amsterdam, The Netherlands.
Cancers (Basel). 2022 May 12;14(10):2389. doi: 10.3390/cancers14102389.
Background: Lymph node metastasis and positive resection margins have been reported to be major determinants of overall survival (OS) and poor recurrence-free survival (RFS) for patients who underwent resection for perihilar cholangiocarcinoma (pCCA). However, the prognostic value of positive lymph nodes independently from resection margin status on OS has not been evaluated. Methods: From the European Cholangiocarcinoma (ENSCCA) registry, patients who underwent resection for pCCA between 1994 and 2021 were included in this retrospective cohort study. The primary outcome was OS stratified for resection margin and lymph node status. The secondary outcome was recurrence-free survival. Results: A total of 325 patients from 11 different centers and six European countries were included. Of these, 194 (59.7%) patients had negative resection margins. In 113 (34.8%) patients, positive lymph nodes were found. Lymph node status, histological grade, and ECOG performance status were independent prognostic factors for survival. The median OS for N0R0, N0R1, N+R0, and N+R1 was 38, 30, 18, and 12 months, respectively (p < 0.001). Conclusion: These data indicate that in the presence of positive regional lymph nodes, resection margin status does not determine OS or RFS in patients with pCCA. Achieving negative margins in patients with positive nodes should not come at the expense of more extensive surgery and associated higher mortality.
据报道，淋巴结转移和切缘阳性是肝门周围胆管癌（pCCA）切除术后患者总生存期（OS）和无复发生存期（RFS）较差的主要决定因素。然而，独立于切缘状态的阳性淋巴结对OS的预后价值尚未得到评估。方法：从欧洲胆管癌（ENSCCA）登记处纳入1994年至2021年间接受pCCA切除术的患者进行这项回顾性队列研究。主要结局是根据切缘和淋巴结状态分层的OS。次要结局是无复发生存期。结果：共纳入来自11个不同中心和6个欧洲国家的325例患者。其中，194例（59.7%）患者切缘阴性。113例（34.8%）患者发现阳性淋巴结。淋巴结状态、组织学分级和ECOG体能状态是生存的独立预后因素。N0R0、N0R1、N+R0和N+R1患者的中位OS分别为38、30、18和12个月（p<0.001）。结论：这些数据表明，在存在区域淋巴结阳性的情况下，切缘状态并不能决定pCCA患者的OS或RFS。在淋巴结阳性的患者中实现切缘阴性不应以更广泛的手术和更高的相关死亡率为代价。
