提高胆管癌术后生存率：在流行地区开展筛查计划的外科策略制定。

Improving postoperative survival in cholangiocarcinoma: development of surgical strategies with a screening program in the epidemic region.

机构信息

Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.

Cholangiocarcinoma Research Institute, Khon Kaen University, Khon Kaen, Thailand.

出版信息

World J Surg Oncol. 2024 Oct 31;22(1):287. doi: 10.1186/s12957-024-03573-5.

DOI:10.1186/s12957-024-03573-5

PMID:39478620

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11526638/

Abstract

BACKGROUND

The Cholangiocarcinoma Screening and Care Program (CASCAP) has been launched since 2013 to detect early-stage cholangiocarcinoma and reduce the disease death. However, the clinical utility of the CASCAP remains unclear. To compare survival outcomes between two time periods: before and after 2013, when significant changes in treatment strategies were implemented, and to evaluate the efficacy of the ultrasound-based screening program, in an Asian region endemic for cholangiocarcinoma.

METHODS

A single-center retrospective review was conducted in curative-intended resection cholangiocarcinoma from 2002 to 2021. Patents characteristics and survival outcomes were compared between 2002 and 2013 (early period) and 2014 to 2021 (later period).

RESULTS

A total of 1091 patients with intrahepatic (n = 624) or perihilar (n = 467) cholangiocarcinoma was included (early period, n = 658; later period, n = 433). Of 66 (15.2%) patients in the later period were referred by the CASCAP. The incidence of early-staged disease (Stage 0 and 1) was lower in early period compared to later period 16.0% versus 29.1% (p < 0.001); that of positive surgical margin was higher in early period 53.7% versus 40.0% (p < 0.001). A median survival time (MST) was 14 months in early and 40 months in later period (p < 0.001). Subgroup analysis by tumor location, the MST was 13 versus 60 months in early and late periods for intrahepatic tumor (p < 0.001), respectively. While MST in perihilar tumor was 18 versus 31 months in early and late periods(p < 0.001), respectively. By presentation, the MST was 51 vs. 38 months, respectively, with screening and usual presentation (p = 0.06).

CONCLUSION

Postoperative survival in CCA patients improved more than doubled during the study period. Moreover, the late period demonstrated enhanced early-stage detection, a higher rate of negative surgical margins, and improved survival outcomes.

摘要

背景

胆管癌筛查和护理计划（CASCAP）自 2013 年启动以来，旨在发现早期胆管癌并降低疾病死亡率。然而，CASCAP 的临床应用效果仍不清楚。本研究旨在比较两个时间段（2013 年之前和之后）的生存结果，在这两个时间段内，治疗策略发生了显著变化，并评估基于超声的筛查计划在亚洲胆管癌高发地区的疗效。

方法

对 2002 年至 2021 年期间进行根治性切除的胆管癌患者进行单中心回顾性研究。比较 2002 年和 2013 年（早期）与 2014 年至 2021 年（后期）之间患者特征和生存结果。

结果

共纳入 1091 例肝内（n=624）或肝门部（n=467）胆管癌患者（早期组 n=658；后期组 n=433）。66 例（15.2%）患者来自 CASCAP。早期组的早期疾病（0 期和 1 期）发生率低于后期组 16.0%比 29.1%（p<0.001）；早期组阳性切缘的发生率高于后期组 53.7%比 40.0%（p<0.001）。早期组的中位生存时间（MST）为 14 个月，后期组为 40 个月（p<0.001）。按肿瘤部位进行亚组分析，肝内肿瘤的 MST 分别为早期和晚期的 13 个月和 60 个月（p<0.001）。肝门部肿瘤的 MST 分别为早期和晚期的 18 个月和 31 个月（p<0.001）。按表现方式，筛查和常规表现的 MST 分别为 51 个月和 38 个月（p=0.06）。