肝门周围胆管癌切缘和淋巴结状态的预后价值

Prognostic value of resection margin and lymph node status in perihilar cholangiocarcinoma.

作者信息

Koca Faruk, Petrova Ekaterina, El Youzouri Hanan, Heil Jan, Heise Michael, Sliwinski Svenja, Bechstein Wolf O, Schnitzbauer Andreas A

机构信息

Goethe University Frankfurt, University Hospital, Department of General, Visceral, Transplant and Thoracic Surgery, Frankfurt, Germany.

出版信息

HPB (Oxford). 2025 Jan;27(1):71-79. doi: 10.1016/j.hpb.2024.09.012. Epub 2024 Oct 1.

DOI:10.1016/j.hpb.2024.09.012

PMID:39455409

Abstract

BACKGROUND

The impact of resection margin and lymph node status on survival in patients undergoing resection for perihilar cholangiocarcinoma (pCCA) is controversial. The aim of this study was to investigate the influence of nodal and resection margin status on long-term survival after resection for pCCA.

METHODS

Retrospective analysis of patients resected for pCCA at the University Hospital Frankfurt, Germany between 1999 and 2022. The patients were categorized in four groups according to resection margin (R) and nodal status (N). Survival was analyzed with univariable and multivariable Cox regression.

RESULTS

Out of 123 patients, 100 with long-term survival were included in the survival analysis. In the univariable analysis, negative resection margin (p = 0.02) and lower grade (p = 0.004) were the only significant positive prognostic factors, while the difference between N0 and N+ was not statistically significant (p = 0.062). Median survival in the groups R0N0, R0N+, R + N0 and R+N+ groups was 40.1, 29.9, 18.4 and 18.9 months, respectively (p = 0.03). In the multivariable analysis, after adjusting for grade, nodal and resection margin status, only grade and resection margin had prognostic significance.

CONCLUSION

Patients with negative resection margin after resection for pCCA have a better prognosis, regardless of the presence of lymph node metastases.

摘要

背景

肝门部胆管癌（pCCA）切除术后切缘和淋巴结状态对患者生存的影响存在争议。本研究旨在探讨淋巴结和切缘状态对pCCA切除术后长期生存的影响。

方法

对1999年至2022年在德国法兰克福大学医院接受pCCA切除术的患者进行回顾性分析。根据切缘（R）和淋巴结状态（N）将患者分为四组。采用单变量和多变量Cox回归分析生存情况。

结果

123例患者中，100例长期生存患者纳入生存分析。单变量分析中，阴性切缘（p = 0.02）和低分级（p = 0.004）是仅有的显著阳性预后因素，而N0和N+之间的差异无统计学意义（p = 0.062）。R0N0、R0N+、R+N0和R+N+组的中位生存期分别为40.1、29.9、18.4和18.9个月（p = 0.03）。多变量分析中，在调整分级、淋巴结和切缘状态后，只有分级和切缘具有预后意义。