De Bellis Mario, Mastrosimini Maria Gaia, Conci Simone, Pecori Sara, Campagnaro Tommaso, Castelli Claudia, Capelli Paola, Scarpa Aldo, Guglielmi Alfredo, Ruzzenente Andrea
Department of Surgery, Dentistry, Gynecology and Pediatrics, Division of General and Hepatobiliary Surgery, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134 Verona, Italy.
Department of Diagnostics and Public Health, Section of Pathology, University of Verona, G.B. Rossi University Hospital, P. le L.A. Scuro 10, 37134 Verona, Italy.
Cancers (Basel). 2022 Dec 12;14(24):6126. doi: 10.3390/cancers14246126.
The evaluation of surgical margins in resected perihilar cholangiocarcinoma (PHCC) remains a challenging issue. Both ductal (DM) and radial margin (RM) should be considered to define true radical resections (R0). Although DM status is routinely described in pathological reports, RM status is often overlooked. Therefore, the frequency of true R0 and its impact on survival might be biased.
To improve the evaluation of RM status and investigate the impact of true R0 on survival.
From 2014 to 2020, 90 patients underwent curative surgery for PHCC at Verona University Hospital, Verona, Italy. Both DM (proximal and distal biliary margin) and RM (hepatic, periductal, and vascular margin) status were evaluated by expert hepatobiliary pathologists. Patients with lymph-node metastases or positive surgical margins (R1) were candidates for adjuvant treatment. Clinicopathological and survival data were retrieved from an institutional database.
True R0 were 46% (41) and overall R1 were 54% (49). RM positivity resulted in being higher than DM positivity (48% versus 27%). Overall survival was better in patients with true R0 than in patients with R1 (median survival time: 53 vs. 28 months; = 0.016). Likewise, the best recurrence-free survival was observed in R0 compared with R1 (median survival time: 32 vs. 15 months; = 0.006). Multivariable analysis identified residual disease status as an independent prognostic factor of both OS ( = 0.009, HR = 2.68, 95% CI = 1.27-5.63) and RFS ( = 0.009, HR = 2.14, 95% CI = 1.20-3.83).
Excellent survival was observed in true R0 patients. The improved evaluation of RM status is mandatory to properly stratify prognosis and select patients for adjuvant treatment.
评估切除的肝门周围胆管癌（PHCC）手术切缘仍然是一个具有挑战性的问题。应同时考虑胆管切缘（DM）和径向切缘（RM）来定义真正的根治性切除（R0）。尽管DM状态在病理报告中常规描述，但RM状态常常被忽视。因此，真正R0的频率及其对生存的影响可能存在偏差。
改进RM状态的评估并研究真正R0对生存的影响。
2014年至2020年，90例患者在意大利维罗纳大学医院接受了PHCC根治性手术。DM（近端和远端胆管切缘）和RM（肝切缘、胆管周围切缘和血管切缘）状态均由肝胆病理专家评估。有淋巴结转移或手术切缘阳性（R1）的患者为辅助治疗候选者。临床病理和生存数据从机构数据库中获取。
真正R0为46%（41例），总体R1为54%（49例）。RM阳性率高于DM阳性率（48%对27%）。真正R0患者的总生存期优于R1患者（中位生存时间：53个月对28个月；P = 0.016）。同样，与R1相比，R0患者的无复发生存期最佳（中位生存时间：32个月对15个月；P = 0.006）。多变量分析确定残留病灶状态是总生存期（P = 0.009，HR = 2.68，95%CI = 1.27 - 5.63）和无复发生存期（P = 0.009，HR = 2.14，95%CI = 1.20 - 3.83）的独立预后因素。
真正R0患者观察到良好的生存情况。改进RM状态的评估对于正确分层预后和选择辅助治疗患者是必不可少的。
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