Margies Rabea, Gröger Lisa-Katharina, Straub Beate K, Bartsch Fabian, Lang Hauke
Department of General, Visceral and Transplant Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
Department of Pathology, University Medical Center, Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131 Mainz, Germany.
Cancers (Basel). 2024 Oct 12;16(20):3463. doi: 10.3390/cancers16203463.
Perihilar cholangiocarcinoma is a rare malignancy of the biliary tract, for which surgery remains the treatment of choice. However, even after radical resection, the prognosis is poor. In addition to tumor size, depth of invasion and nodal/metastatic status, the TNM classification includes additional parameters such as perineural (Pn), lymphangio (L) and vascular (V) invasion. The prognostic impact of these factors is not yet fully understood. The aim of this study was to investigate the influence of these parameters on overall survival after resection of perihilar cholangiocarcinoma.
Data from all patients who underwent surgical exploration for perihilar cholangiocarcinoma between January 2013 and December 2023 were included into an institutional database. The impact of perineural, lymphangio and vascular invasion on overall survival was analyzed.
Over the 11-year period, a total of 214 patients underwent surgical exploration for perihilar cholangiocarcinoma. Curative intended resection was possible in 168 patients (78.5%). Perineural invasion, lymphangio invasion and vascular invasion were present in 79.2%, in 17.3% and in 14.3% of patients, respectively. Cross tabulation revealed a significant association between the presence of L1 and V1 ( = 0.006). There was also a significant association of Pn1, L1, and V1 with R-status ( = 0.010; = 0.006 and ≤ 0.001). While V1 was associated with significantly worse overall survival across the entire cohort, Pn1 alone showed only a tendency towards worse overall survival without reaching statistical significance. In Bismuth type IV, both L1 and V1, but not Pn1, were significantly associated with worse overall survival ( = 0.001; = 0.017 and = 0.065).
Perineural invasion is very common in perihilar cholangiocarcinoma. Although Pn1 was associated with a tendency toward worse survival, it did not reach statistical significance. In contrast, vascular invasion significantly worsened overall survival in the entire cohort, and lymphangio invasion was linked to worse overall survival in Bismuth type IV tumors. The combination of perineural invasion with positivity of more than one additional factor (either L or V) was also associated with worse overall survival. In patients with Bismuth type IV, these pathological markers appeared to have even greater prognostic relevance.
肝门部胆管癌是一种罕见的胆道恶性肿瘤，手术仍是其首选治疗方法。然而，即使进行了根治性切除，预后仍较差。除肿瘤大小、浸润深度和淋巴结/转移状态外，TNM分类还包括其他参数，如神经周围（Pn）、淋巴管（L）和血管（V）侵犯。这些因素对预后的影响尚未完全明确。本研究旨在探讨这些参数对肝门部胆管癌切除术后总生存的影响。
将2013年1月至2023年12月期间所有因肝门部胆管癌接受手术探查的患者数据纳入机构数据库。分析神经周围、淋巴管和血管侵犯对总生存的影响。
在这11年期间，共有214例患者因肝门部胆管癌接受手术探查。168例患者（78.5%）可行根治性切除。神经周围侵犯、淋巴管侵犯和血管侵犯分别见于79.2%、17.3%和14.3%的患者。交叉表显示L1和V1的存在之间存在显著关联（P = 0.006）。Pn1、L1和V1与R状态也存在显著关联（P = 0.010；P = 0.006和P≤0.001）。虽然V1与整个队列中显著更差的总生存相关，但单独的Pn1仅显示出总生存更差的趋势，未达到统计学意义。在Bismuth IV型中，L1和V1均与更差的总生存显著相关，但Pn1不相关（P = 0.001；P = 0.017和P = 0.065）。
神经周围侵犯在肝门部胆管癌中非常常见。虽然Pn1与生存更差的趋势相关，但未达到统计学意义。相比之下，血管侵犯显著恶化了整个队列的总生存，淋巴管侵犯与Bismuth IV型肿瘤中更差的总生存相关。神经周围侵犯与一种以上其他因素（L或V）阳性的组合也与更差的总生存相关。在Bismuth IV型患者中，这些病理标志物似乎具有更大的预后相关性。
