Sahai Puja, Rastogi Archana, Gupta Ajay, Patil Nilesh S, Sharma Namita, Mohapatra Nihar, Sharma Archana, Rudrakumar Karthika, Jindal Ankur, Mukund Amar, Kumar Guresh, Pamecha Viniyendra, Yadav Hanuman P
Department of Radiation Oncology, Institute of Liver and Biliary Sciences, New Delhi, India.
Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India.
Euroasian J Hepatogastroenterol. 2024 Jul-Dec;14(2):134-144. doi: 10.5005/jp-journals-10018-1440. Epub 2024 Dec 27.
The purpose of the present study was to evaluate clinicopathological characteristics, patterns of recurrence, survival outcomes, and implications for the addition of chemoradiotherapy for patients with resected perihilar and intrahepatic cholangiocarcinoma (CCA).
For the present retrospective study, we identified 38 and 10 patients with resected perihilar and intrahepatic CCA. In perihilar CCA, adjuvant treatment was given as chemotherapy ( = 13) or chemoradiotherapy ( = 10). In intrahepatic CCA, neoadjuvant treatment was given with transarterial chemoembolization (TACE, = 1) or chemotherapy plus stereotactic body radiation therapy (SBRT, = 1), and adjuvant treatment was given to 7 patients with chemotherapy or chemoradiotherapy.
In perihilar CCA, preoperative biliary drainage procedures were performed in 27 out of 30 patients with jaundice. The adjacent liver showed secondary sclerosing cholangitis ( = 5) and fibrosis ( = 19). Locoregional recurrence involved the hepaticojejunostomy anastomotic site and lymph nodes. In intrahepatic CCA, the adjacent liver revealed cirrhosis ( = 1), secondary sclerosing cholangitis ( = 1), and fibrosis ( = 6). The sites of recurrence were in the remnant liver and lymph nodes ( = 6). In perihilar CCA, the median overall survival (OS) and disease-free survival (DFS) rates were 30.1 months (95% CI: 22.9-37.4) and 15.1 months (95% CI: 9.74-20.5), respectively. The 2-year and 3-year OS were 60.5% and 44.7%, respectively. Multivariate analysis revealed a significant association of no adjuvant treatment with decreased DFS ( = 0.004), HR 4.03 (95% CI: 1.57-10.4). Recurrence showed an unfavorable association with OS ( = 0.056), HR 2.90 (95% CI: 0.98-8.66). In intrahepatic CCA, the median OS and DFS rates were 41.2 months (95% CI: 13.5-68.9) and 10.8 months (95% CI: 1.98-19.6), respectively. The 2-year and 3-year OS were 66.7% and 53.3%, respectively. The patient with multiple intrahepatic CCA lesions and treated with neoadjuvant chemotherapy and SBRT showed partial pathological necrosis after resection and was disease-free at 3.5 years.
The present study showed the effectiveness of the combination of chemoradiotherapy with resection in improving locoregional disease control and survival in patients with perihilar and intrahepatic CCA.
Sahai P, Rastogi A, Gupta A, Perihilar and Intrahepatic Cholangiocarcinoma after Resection: Clinicopathological Characteristics, Outcomes, and Implications for Addition of Chemoradiotherapy. Euroasian J Hepato-Gastroenterol 2024;14(2):134-144.
本研究旨在评估肝门部及肝内胆管癌（CCA）切除术后患者的临床病理特征、复发模式、生存结局以及放化疗联合应用的意义。
在这项回顾性研究中，我们确定了38例肝门部CCA患者和10例肝内CCA患者。在肝门部CCA中，辅助治疗采用化疗（n = 13）或放化疗（n = 10）。在肝内CCA中，新辅助治疗采用经动脉化疗栓塞术（TACE，n = 1）或化疗联合立体定向体部放疗（SBRT，n = 1），7例患者接受了化疗或放化疗作为辅助治疗。
在肝门部CCA中，30例黄疸患者中有27例进行了术前胆道引流术。邻近肝脏显示继发性硬化性胆管炎（n = 5）和纤维化（n = 19）。局部复发累及肝空肠吻合口和淋巴结。在肝内CCA中，邻近肝脏显示肝硬化（n = 1）、继发性硬化性胆管炎（n = 1）和纤维化（n = 6）。复发部位在残余肝脏和淋巴结（n = 6）。在肝门部CCA中，中位总生存期（OS）和无病生存期（DFS）分别为30.1个月（95%CI：22.9 - 37.4）和15.1个月（95%CI：9.74 - 20.5）。2年和3年OS分别为60.5%和44.7%。多因素分析显示，未接受辅助治疗与DFS降低显著相关（P = 0.004），风险比（HR）为4.03（95%CI：1.57 - 10.4）。复发与OS呈不良关联（P = 0.056），HR为2.90（95%CI：0.98 - 8.66）。在肝内CCA中，中位OS和DFS分别为41.2个月（95%CI：13.5 - 68.9）和10.8个月（95%CI：1.98 - 19.6）。2年和3年OS分别为66.7%和53.3%。患有多个肝内CCA病灶并接受新辅助化疗和SBRT治疗的患者在切除术后显示部分病理坏死，3.5年时无疾病。
本研究表明，放化疗联合手术切除在改善肝门部及肝内CCA患者的局部疾病控制和生存方面是有效的。
Sahai P, Rastogi A, Gupta A, 肝门部及肝内胆管癌切除术后：临床病理特征、结局及放化疗联合应用的意义。《欧亚肝脏胃肠病学杂志》2024；14(2)：134 - 144。
