Department of Surgery, Sunpasitthiprasong Hospital, 122 Sunpasit Road, Nai Mueang Subdistrict, Mueang Ubon Ratchathani District, Ubon Ratchathani, 34000, Thailand.
World J Surg Oncol. 2024 Nov 27;22(1):314. doi: 10.1186/s12957-024-03596-y.
Cholangiocarcinoma (CCA) is an adenocarcinoma of the hepatobiliary system, which can be classified into intrahepatic (iCCA), perihilar (pCCA) and distal (dCCA). Surgical resection is the curative treatment for all subtypes of CCA. This study evaluates patients with CCA who underwent surgery and determines factors that impact their survival.
We conducted a retrospective analysis of 720 patients diagnosed with CCA from October 2013 to December 2018. Patients were categorized into iCCA (n = 398), pCCA (n = 237), and dCCA (n = 85) based on tumor location. Data including demographic information, clinical presentation, treatment modalities, and survival statistics were collected and analyzed.
The overall resectability rate was 78.3%, with resectability highest in pCCA patients (83.5%). Overall median survival time (MST) was 11.6 months and varied among subtypes: iCCA 10.9 months, pCCA 11.2 months, and dCCA 15.4 months. Patients underwent curative-intent resection significantly improved survival compared to those with palliative resection or unresectable disease in all subtypes. R0 resection patients had better overall survival (OS) than R1 resection patients: 5-year survival rate of 20.2% vs. 4.3% in all CCA (p < 0.001), 21.4% vs. 7% in iCCA (p < 0.001), 17.2% vs. 0% in pCCA (p < 0.001), and 23.1% vs. 0% in dCCA (p = 0.105), respectively. Positive resection margin was an independent prognostic factor for OS in pCCA and iCCA.
Surgical resection is the only cure for CCA. Curative-intent resection is more effective than palliative resection in improving survival rates. When performing curative-intent resection, the goal is R0 resection. This is because it improves overall survival over R1 resection.
胆管癌（CCA）是肝胆系统的腺癌，可分为肝内型（iCCA）、肝门周围型（pCCA）和远端型（dCCA）。手术切除是所有 CCA 亚型的治愈性治疗方法。本研究评估了接受手术治疗的 CCA 患者，并确定了影响其生存的因素。
我们对 2013 年 10 月至 2018 年 12 月期间诊断为 CCA 的 720 例患者进行了回顾性分析。根据肿瘤位置将患者分为 iCCA（n=398）、pCCA（n=237）和 dCCA（n=85）。收集并分析了包括人口统计学信息、临床表现、治疗方式和生存统计数据。
总体可切除率为 78.3%，pCCA 患者的可切除率最高（83.5%）。总体中位生存时间（MST）为 11.6 个月，各亚型之间存在差异：iCCA 为 10.9 个月，pCCA 为 11.2 个月，dCCA 为 15.4 个月。所有亚型中，与姑息性切除或不可切除疾病相比，接受根治性切除的患者的生存明显改善。R0 切除患者的总体生存率（OS）优于 R1 切除患者：所有 CCA 的 5 年生存率为 20.2% vs. 4.3%（p<0.001），iCCA 为 21.4% vs. 7%（p<0.001），pCCA 为 17.2% vs. 0%（p<0.001），dCCA 为 23.1% vs. 0%（p=0.105）。阳性切缘是 pCCA 和 iCCA 患者 OS 的独立预后因素。
手术切除是 CCA 的唯一治愈方法。与姑息性切除相比，根治性切除更能提高生存率。在进行根治性切除时，目标是 R0 切除，因为这可以提高整体生存率，优于 R1 切除。
