Kawashima Jun, Akabane Miho, Tsilimigras Diamantis I, Woldesenbet Selamawit, Khalil Mujtaba, Endo Yutaka, Sahara Kota, Aucejo Federico, Marques Hugo P, Chumbinho Beatriz, Hugh Tom, Maithel Shishir K, Groot Koerkamp Bas, Ruzzenente Andrea, Endo Itaru, Pawlik Timothy M
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA; Department of Gastroenterological Surgery, Yokohama City University, School of Medicine, Yokohama, Japan.
Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH, USA.
HPB (Oxford). 2025 Sep;27(9):1158-1167. doi: 10.1016/j.hpb.2025.05.010. Epub 2025 May 27.
We sought to evaluate the prognostic significance of perineural invasion (PNI) among patients undergoing curative-intent resection for perihilar cholangiocarcinoma (pCCA), with a specific focus on early-stage disease.
Data from patients who underwent curative-intent resection for pCCA were collected from eight high-volume international hepatobiliary centers. The association between PNI status, clinicopathological features, and long-term survival was analyzed in both the overall cohort and a subset of patients with early-stage pCCA.
Among 435 patients, 364 (83.7 %) were PNI-positive. At the time of surgery, 53 patients with PNI underwent margin re-resection; only 19 (35.8 %) achieved a final R0 margin, whereas 34 (64.2 %) had a persistent R1 margin on the final pathological examination. PNI was independently associated with worse overall survival in the entire cohort (HR 1.52), as well as among patients with T1/2 (HR 1.53) and node-negative (HR 1.60) disease. Although not associated with improved survival among node-negative patients, adjuvant chemotherapy provided a survival benefit among patients with node-negative disease who had PNI (50.8 months vs. 28.6 months; p = 0.044).
PNI was an independent predictor of long-term survival, particularly among patients with early-stage pCCA.
我们旨在评估肝门周围胆管癌（pCCA）行根治性切除患者中神经周围侵犯（PNI）的预后意义，特别关注早期疾病。
从八个高容量国际肝胆中心收集接受pCCA根治性切除患者的数据。在整个队列以及早期pCCA患者亚组中分析PNI状态、临床病理特征与长期生存之间的关联。
在435例患者中，364例（83.7%）PNI阳性。手术时，53例PNI患者接受了切缘再次切除；最终病理检查时，仅19例（35.8%）达到R0切缘，而34例（64.2%）仍有R1切缘。PNI与整个队列中较差的总生存期独立相关（HR 1.52），在T1/2期（HR 1.53）和无淋巴结转移（HR 1.60）疾病患者中也是如此。辅助化疗虽未使无淋巴结转移患者的生存期延长，但为有PNI的无淋巴结转移疾病患者提供了生存获益（50.8个月对28.6个月；p = 0.044）。
PNI是长期生存的独立预测因素，尤其是在早期pCCA患者中。
