Department of General Surgery, Zhong-Xing Branch, Taipei City Hospital, Taipei, Taiwan.
Department of General Surgery, National Taiwan University Hospital, Taipei, Taiwan.
Sci Rep. 2024 Aug 17;14(1):19084. doi: 10.1038/s41598-024-70124-z.
Intrahepatic cholangiocarcinoma (ICC) is the second commonly-seen liver malignancy and one of the most fatal cancers in Taiwan. Survival after diagnosis of ICC remains poor. This study aimed to investigate the survival and prognostic factors in patients with ICC. All patients with newly diagnosed ICC during 2004 to 2018 were identified from a national cancer database and followed until December 2020. Estimates of overall survival (OS) were conducted using the Kaplan-Meier method and Cox proportional hazards model. Hazard ratios with 95% confidence intervals were calculated. Initially, 7940 patients with ICC disease (stage IV: 55.6%, 4418/7940) were eligible for this study. Only 32.3% (2563/7940) patients with ICC underwent liver resection. After Propensity score matching, 969 pairs (N = 1938) of patients were matched and selected (mean age 62.8 ± 11.0 years, 53.1% were male, 29.7% had cirrhosis). The median follow-up time was 80.0 months (range 25-201 months). The 3-, 5-year OS rates were 44.0%, 36.4% in the surgical group and 26.0%, 23.7% in the non-surgical group, respectively. Surgery, young patients (≤ 54 years), small tumor size, no vascular invasion and chemotherapy were associated with better OS in patients with stages I-III disease. Surgery benefit was maximum in stage I disease followed by stage II. In patients with stage IV disease, factors such as surgery, young patients (≤ 64 years), single tumor, and no vascular invasion were associated with better OS. Chemotherapy was insignificantly associated with better OS. Long-term survival in patients with ICC is very poor. Compared to non-surgical patients, surgery conveys approximately 18% and 12% better OS rates at 3-year and 5-year, respectively. Early detection and surgical intervention may improve OS substantially in patients with ICC.
肝内胆管细胞癌（ICC）是第二常见的肝脏恶性肿瘤，也是台湾最致命的癌症之一。ICC 患者的诊断后生存仍然较差。本研究旨在探讨 ICC 患者的生存和预后因素。从国家癌症数据库中确定了 2004 年至 2018 年间所有新诊断为 ICC 的患者，并随访至 2020 年 12 月。使用 Kaplan-Meier 方法和 Cox 比例风险模型进行总体生存（OS）估计。计算了具有 95%置信区间的风险比。最初，7940 例 ICC 疾病患者（IV 期：55.6%，4418/7940）符合本研究条件。仅 32.3%（2563/7940）的 ICC 患者接受了肝切除术。在进行倾向评分匹配后，选择了 969 对（N=1938）患者进行匹配（平均年龄 62.8±11.0 岁，53.1%为男性，29.7%有肝硬化）。中位随访时间为 80.0 个月（范围 25-201 个月）。手术组的 3 年和 5 年 OS 率分别为 44.0%和 36.4%，非手术组分别为 26.0%和 23.7%。手术、年轻患者（≤54 岁）、肿瘤体积小、无血管侵犯和化疗与 I-III 期疾病患者的 OS 相关。手术获益在 I 期疾病中最大，其次是 II 期疾病。在 IV 期疾病患者中，手术、年轻患者（≤64 岁）、单发肿瘤和无血管侵犯与更好的 OS 相关。化疗与更好的 OS 无显著相关性。ICC 患者的长期生存情况非常差。与非手术患者相比，手术分别使 3 年和 5 年的 OS 率提高了约 18%和 12%。早期发现和手术干预可能会显著提高 ICC 患者的 OS。
