Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Yamane, Hidaka-City, Saitama-Pref, Japan.
Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Yamane, Hidaka-City, Saitama-Pref, Japan.
Eur J Surg Oncol. 2024 Dec;50(12):108691. doi: 10.1016/j.ejso.2024.108691. Epub 2024 Sep 18.
Patients with distal cholangiocarcinoma (DCC) frequently receive adjuvant chemotherapy in preoperative and postoperative settings, but prediction of prognostic risk at the time of treatment selection remains challenging.
This single-center retrospective study enrolled DCC patients who underwent initial pancreatoduodenectomy (PD) between 2009 and 2022. Preoperative clinical parameters were collected, and Cox regression analysis was used to identify risk factors for overall survival (OS).
Among 170 patients examined, the median tumor depth was 10 mm, and 37 % of the patients were diagnosed with pT3. Overall, 46 % of patients had lymph node metastasis. The median and 5-year OS was 58.2 months and 50 %, respectively. Multivariate analysis revealed tumor size on computed tomography (CT) ≥15 mm and main pancreatic duct (MPD) dilatation (≥3 mm) as independent risk factors for OS among various preoperative parameters; the prognosis was stratified based on these two parameters. Patients with one risk factor had similar outcomes (5-year OS: 39 %) to pStage IIB DCC (pT2N1 or pT3), while those with two risk factors had a prognosis akin to pStage IIIA (pN2), with a high early recurrence rate of 64 % (5-year OS: 8 %). Among non-risk group patients with low carbohydrate antigen (CA)19-9 levels (<37 U/mL), the prognosis was comparable (5-year OS: 72 %) to those with pStage I DCC.
A simple stratification approach was developed to predict long-term postoperative outcomes. To improve poor prognosis, intensive therapy, including neoadjuvant chemotherapy, should be considered for patients with two risk factors.
远端胆管癌（DCC）患者常在术前和术后接受辅助化疗，但在治疗选择时预测预后风险仍然具有挑战性。
本单中心回顾性研究纳入了 2009 年至 2022 年间接受初始胰十二指肠切除术（PD）的 DCC 患者。收集了术前临床参数，并采用 Cox 回归分析确定总生存期（OS）的危险因素。
在 170 例患者中，肿瘤深度的中位数为 10mm，37%的患者诊断为 pT3。总体而言，46%的患者存在淋巴结转移。中位 OS 和 5 年 OS 分别为 58.2 个月和 50%。多变量分析显示，CT 上肿瘤大小≥15mm 和主胰管（MPD）扩张（≥3mm）是各种术前参数中 OS 的独立危险因素；根据这两个参数对预后进行分层。有一个危险因素的患者与 pStage IIB DCC（pT2N1 或 pT3）的结局相似（5 年 OS：39%），而有两个危险因素的患者预后与 pStage IIIA（pN2）相似，早期复发率高达 64%（5 年 OS：8%）。在非风险组中，CA19-9 水平较低（<37U/mL）的患者预后与 pStage I DCC 相似（5 年 OS：72%）。
提出了一种简单的分层方法来预测长期术后结局。为了改善不良预后，对于有两个危险因素的患者，应考虑强化治疗，包括新辅助化疗。
