预测肝门部胆管癌患者根治性切除术后结局的术后因素——一项为期10年的单中心经验

Postoperative factors predicting outcomes in patients with Perihilar cholangiocarcinoma undergoing curative resection-a 10-year single-center experience.

作者信息

Ahmad Al-Saffar Hasan, Schultz Nicolai, Larsen Peter Nørrgaard, Fallentin Eva, Willemoe Gro Linno, Renteria Ramirez Diana Elena, Knøfler Lucas Alexander, Pommergaard Hans-Christian

机构信息

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.

出版信息

Scand J Gastroenterol. 2025 Jan;60(1):73-80. doi: 10.1080/00365521.2024.2443515. Epub 2024 Dec 18.

DOI:10.1080/00365521.2024.2443515

PMID:39692292

Abstract

BACKGROUND

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.

METHOD

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).

RESULTS

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.

CONCLUSION

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.

摘要

背景

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。

方法

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。

结果

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。