Ahmad Al-Saffar Hasan, Schultz Nicolai, Larsen Peter Nørrgaard, Fallentin Eva, Willemoe Gro Linno, Renteria Ramirez Diana Elena, Knøfler Lucas Alexander, Pommergaard Hans-Christian
Department of Surgery and Transplantation, Centre for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Hepatic Malignancy Surgical Research Unit (HEPSURU), Department of Surgery and Transplantation, Centre for Cancer and Organ Diseases, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark.
Scand J Gastroenterol. 2025 Jan;60(1):73-80. doi: 10.1080/00365521.2024.2443515. Epub 2024 Dec 18.
Perihilar cholangiocarcinoma (pCCA) has a 5-year overall survival (OS) ranging from 10-40%, following resection. However, prognostic models for postoperative outcomes are limited by long study timespan and variations in work-up. We investigated postoperative outcomes in patients resected for pCCA in a high-volume center with standardized work-up.
Patients resected with confirmed pCCA, between 2013 and 2023, were included. Cox-regression investigated association between postoperative factors and OS as well as disease-free survival (DFS).
Totally, 65 patients were resected for pCCA. The 1-, 3- and 5-year OS rates were 86.1%, 56.5% and 32.6% respectively. The 1-, 3- and 5-year DFS rates were 67.7%, 40.0% and 26.8%, respectively. Portal vein embolization (PVE) (HR 4.52 [CI 1.66-12.27], = 0.003), lymph node metastasis (LNM) (HR 6.37 [CI 2.06-19.67], = 0.001) and Clavien-Dindo (CD) ≥3a (HR 2.83 [CI 1.43-5.56], = 0.002) were associated with inferior OS. Clavien-Dindo (CD) ≥3a (HR 2.10 [CI 1.05-4.22], = 0.03) and T-stage >2 (HR 2.36 [CI 1.01, 5.05], = 0.04) were associated with inferior and superior DFS, respectively.
PVE, T-stage >2, LNM and CD ≥ III were associated with worse prognosis in resected pCCA. Research is needed to improve pre-operative detection of oncological features and patients with risk of major surgical complications.
肝门部胆管癌（pCCA）切除术后的5年总生存率（OS）为10% - 40%。然而，术后结果的预后模型受到研究时间跨度长和检查方法差异的限制。我们在一个进行标准化检查的高容量中心，研究了接受pCCA切除术患者的术后结果。
纳入2013年至2023年间确诊为pCCA并接受手术切除的患者。Cox回归分析了术后因素与总生存率以及无病生存率（DFS）之间的关联。
共有65例患者接受了pCCA切除术。1年、3年和5年的总生存率分别为86.1%、56.5%和32.6%。1年、3年和5年的无病生存率分别为67.7%、40.0%和26.8%。门静脉栓塞（PVE）（风险比[HR] 4.52 [置信区间（CI）1.66 - 12.27]，P = 0.003）、淋巴结转移（LNM）（HR 6.37 [CI 2.06 - 19.67]，P = 0.001）和Clavien - Dindo（CD）≥3a（HR 2.83 [CI 1.43 - 5.56]，P = 0.002）与较差的总生存率相关。Clavien - Dindo（CD）≥3a（HR 2.10 [CI 1.05 - 4.22]，P = 0.03）和T分期>2（HR 2.36 [CI 1.01, 5.05]，P = 0.04）分别与较差和较好的无病生存率相关。
PVE、T分期>2、LNM和CD≥III与接受手术切除的pCCA患者预后较差相关。需要开展研究以改善肿瘤特征的术前检测以及存在重大手术并发症风险的患者的检测。
