Feng Jian, Liang Bin, Zhang Hang-Yu, Liu Zhe, Jiang Kai, Zhao Xiang-Qian
Department of Hepatopancreatobiliary Surgery, Peking University Shougang Hospital, Beijing 100144, China.
Faculty of Hepato-Pancreato-Biliary Surgery, Institute of Hepatobiliary Surgery of Chinese PLA, Key Laboratory of Digital Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China.
World J Gastrointest Surg. 2022 May 27;14(5):442-451. doi: 10.4240/wjgs.v14.i5.442.
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis. According to the Liver Cancer Study Group of Japan classification, ICC can be divided into three types: Mass-forming (MF) type, periductal-infiltrating (PI) type, and intraductal-growth type. The MF type is the most common, accounting for 57.1-83.6% of ICCs. Nevertheless, little is known about the epidemiology and treatment of MF ICC.
To examine the prognostic factors for patients with MF ICC.
We carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018. According to the treatment received, the patients were divided into either a resection group or an exploration group.
The pooled 1-, 3-, and 5-year survival rates in the 68 patients with MF ICC were 66.5%, 36.3%, and 9.3%, respectively. Univariate analysis revealed that surgical resection ( 0.001), nodal metastasis ( 0.001), tumor location ( = 0.039), vascular invasion ( 0.001), ascites ( 0.001), and differentiation ( = 0.009) were significantly associated with the prognosis and survival of MF ICC. Multivariate analysis revealed that ascites (hazard ratio [HR] = 5.6, 95% confidence interval [CI]: 1.6-18.9, = 0.006) and vascular invasion (HR = 2.5, 95%CI: 1.0-6.1, = 0.045) were independent risk factors for MF ICC. The pooled 1-, 3-, and 5-year survival rates in the 19 patients of the exploration group were 5.3%, 5.3%, and 0, respectively. Among the 49 patients who underwent surgical resection, the pooled 1-, 3-, and 5-year survival rates were 93.5%, 49.7%, and 14.4%, respectively. Univariate and multivariate analyses revealed that vascular invasion (HR = 3.1, 95%CI: 1.2-8.5, = 0.024) and nodal metastasis (HR = 3.2, 95%CI: 1.4-7.6, = 0.008) were independent prognostic risk factors for surgical resection patients.
The prognosis of MF ICC patients is dismal, especially those with ascites or vascular invasion. Surgical resection is a key factor in improving overall survival in patients with MF ICC, and vascular invasion and lymph node metastasis affect the efficacy of surgical resection.
肝内胆管癌（ICC）是仅次于肝细胞癌的人类第二常见原发性肝癌，是一种罕见的上皮性恶性肿瘤，预后较差。根据日本肝癌研究组的分类，ICC可分为三种类型：肿块形成型（MF型）、胆管周围浸润型（PI型）和管内生长型。MF型最为常见，占ICC的57.1 - 83.6%。然而，关于MF ICC的流行病学和治疗知之甚少。
探讨MF ICC患者的预后因素。
我们对2008年1月至2018年12月在中国人民解放军总医院肝胆胰外科接受治疗的连续MF ICC患者进行了回顾性分析。根据接受的治疗，将患者分为切除组或探查组。
68例MF ICC患者的1年、3年和5年总生存率分别为66.5%、36.3%和9.3%。单因素分析显示，手术切除（P = 0.001）、淋巴结转移（P = 0.001）、肿瘤位置（P = 0.039）、血管侵犯（P = 0.001）、腹水（P = 0.001）和分化程度（P = 0.009）与MF ICC的预后和生存显著相关。多因素分析显示，腹水（风险比[HR]=5.6，95%置信区间[CI]：1.6 - 18.9，P = 0.006）和血管侵犯（HR = 2.5，95%CI：1.0 - 6.1，P = 0.045）是MF ICC的独立危险因素。探查组19例患者的1年、3年和5年总生存率分别为5.3%、5.3%和0。在49例行手术切除的患者中，1年、3年和5年总生存率分别为93.5%、49.7%和14.4%。单因素和多因素分析显示，血管侵犯（HR = 3.1，95%CI：1.2 - 8.5，P = 0.024）和淋巴结转移（HR = 3.2，95%CI：1.4 - 7.6，P = 0.008）是手术切除患者的独立预后危险因素。
MF ICC患者的预后很差，尤其是有腹水或血管侵犯的患者。手术切除是提高MF ICC患者总生存率的关键因素，血管侵犯和淋巴结转移影响手术切除的疗效。
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