Al-Saffar H A, Larsen P N, Schultz N, Kristensen T S, Renteria D E, Knøfler L A, Pommergaard H C
Department of Surgery and Transplantation, Centre for Cancer and Organ Diseases, Rigshospitalet, 2100, Copenhagen, Denmark.
Hepatic Malignancy Surgical Research Unit (HEPSURU), Department of Surgery and Transplantation, Centre for Cancer and Organ Diseases, Rigshospitalet, 2100, Copenhagen, Denmark.
Langenbecks Arch Surg. 2024 Dec 21;410(1):13. doi: 10.1007/s00423-024-03583-7.
Perihilar cholangiocarcinoma (pCCA) is a rare malignancy requiring resection of extrahepatic bile ducts with or without hepatectomy. Prognostic models for post-operative outcomes in pCCA are unusable in pre-operative decision-making as most are based on post-operative variables. Additionally, no pre-operative models include futile laparotomy or benign hilar stenosis (BHS) as possible outcomes. We investigated pre-operative predictive factors for non-resectability, disease-free survival (DFS), and overall survival (OS), in patients referred for resection of suspected pCCA.
Patients with suspected pCCA evaluated at multidisciplinary team (MDT) conference and referred for curative resection at Rigshospitalet, from 2013-2023. Outcomes were preoperative factors related to OS, DFS and non-resectability.
Ninety-three patients with suspected pCCA were considered resectable at MDT, of which 84 (90.3 %) were confirmed pCCA. Nineteen (20.4 %) with pCCA were non-resectable. Patients with non-resectable pCCA had higher pre-operative p-bilirubin and ECOG-performance status (ECOG-PS) compared to resected pCCA and BHS (p=0.02 and 0.01). Portal vein embolization (PVE), higher ECOG-PS and elevated p-bilirubin were associated with worse OS in patients with pCCA undergoing surgical exploration [(HR 2.45 (95% CI 1.32-4.56), p=0.004), (HR 2.32 (95% CI 1.30-4.09), p=0.004) and (HR 2.03 (95% CI 1.17-3.51), p=0.01), respectively]. PVE and larger tumor size were associated with poorer DFS [HR 3.29 (95 % CI 1.64- 6.60), p=0.001) and (HR 1.02 (95% CI 1.00-1.04), p=0.003) respectively].
Poor ECOG-PS, PVE, elevated p-bilirubin and larger tumor size were associated with adverse survival in patients with pCCA undergoing surgical exploration. Non-resectable pCCA were associated with higher rates of elevated p-bilirubin and larger tumor size.
肝门部胆管癌（pCCA）是一种罕见的恶性肿瘤，需要切除肝外胆管，可伴或不伴肝切除术。pCCA术后预后模型在术前决策中无法使用，因为大多数模型基于术后变量。此外，没有术前模型将无效剖腹手术或良性肝门狭窄（BHS）作为可能的结果纳入。我们调查了疑似pCCA行切除术患者的术前不可切除性、无病生存期（DFS）和总生存期（OS）的预测因素。
2013年至2023年期间，在综合多学科团队（MDT）会议上评估并转诊至里格霍斯皮塔尔进行根治性切除的疑似pCCA患者。观察指标为与OS、DFS和不可切除性相关的术前因素。
93例疑似pCCA患者在MDT会议上被认为可切除，其中84例（90.3%）确诊为pCCA。19例（20.4%）pCCA患者不可切除。与可切除的pCCA和BHS相比，不可切除pCCA患者术前的总胆红素和美国东部肿瘤协作组体能状态（ECOG-PS）更高（p=0.02和0.01）。接受手术探查的pCCA患者中，门静脉栓塞（PVE）、较高的ECOG-PS和升高总胆红素与较差的OS相关[风险比（HR）分别为2.45（95%置信区间1.32-4.56），p=0.004）、（HR 2.32（95%置信区间1.30-4.09），p=0.004）和（HR 2.03（95%置信区间1.17-3.51），p=0.01）]。PVE和更大的肿瘤大小与较差的DFS相关[HR分别为3.29（95%置信区间1.64-6.60），p=0.001）和（HR 1.02（95%置信区间1.00-1.04），p=0.003）]。
较差的ECOG-PS、PVE、升高的总胆红素和更大的肿瘤大小与接受手术探查 的pCCA患者的不良生存相关。不可切除的pCCA与更高的总胆红素升高率和更大的肿瘤大小相关。
