Meister Franziska A, Joechle Katharina, Tessmer Philipp, Belger Esref, Roeth Anjali A, Beetz Oliver, Oldhafer Felix, Bednarsch Jan, Neumann Ulf P, Schneider Carolin V, Siepmann Robert, Amygdalos Iakovos, Vondran Florian W R, Czigany Zoltan
Department of General, Visceral, Pediatric and Transplantation Surgery, University Hospital RWTH Aachen, 52074 Aachen, Germany.
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, 45147 Essen, Germany.
Cancers (Basel). 2025 Jul 1;17(13):2213. doi: 10.3390/cancers17132213.
: Cholangiocarcinoma (CCA) of the liver is a highly aggressive cancer that arises from malignant cells in the bile ducts. Radical surgery remains the only curative option, but major liver resection carries high perioperative risks. This study investigates the predictive value of preoperative bone mineral density (BMD), measured via CT, for perioperative complications, mortality, and long-term outcomes. : The analysis included 202 patients who underwent curative-intent surgery for intrahepatic cholangiocarcinoma (iCCA; n = 97) or perihilar cholangiocarcinoma (pCCA; n = 105) between 2010 and 2019. Preoperative bone mineral density (BMD) was assessed using computed tomography segmentation at the level of the 12th thoracic vertebra. Osteopenia was defined according to established cutoffs. : Osteopenia was highly prevalent in both iCCA (53/97, 54%) and pCCA (54/105, 51%) subcohorts. Patients suffering from osteopenia were significantly older than those without (71.1 [62-76.6] years vs. 61.3 [52.9-69.2] years; < 0.001). Alteration in BMD did not demonstrate a significant prognostic effect in terms of perioperative morbidity (Mann-Whitney U; comprehensive complication index-CCI: 34 [9-56] vs. 40 [21-72] = 0.185; iCCA: = 0.803; pCCA: = 0.165). The median overall survival in our cohort was 19 [14-25] months. Patients with osteopenia did not exhibit a significantly different overall survival compared to those with normal bone mineral density (log-rank = 0.234). : In contrast to our previous observations in other oncological patient cohorts, osteopenia alone had no significant negative impact on clinical outcomes in our large European cohort of patients undergoing curative-intent surgery for CCA. To validate these findings, further prospective studies are warranted.
肝内胆管癌（CCA）是一种侵袭性很强的癌症，由胆管中的恶性细胞引发。根治性手术仍然是唯一的治愈选择，但大范围肝切除具有较高的围手术期风险。本研究调查了通过CT测量的术前骨密度（BMD）对围手术期并发症、死亡率和长期预后的预测价值。
该分析纳入了2010年至2019年间接受根治性手术治疗肝内胆管癌（iCCA；n = 97）或肝门周围胆管癌（pCCA；n = 105）的202例患者。使用计算机断层扫描分割法在第12胸椎水平评估术前骨密度（BMD）。骨质减少根据既定的临界值定义。
骨质减少在iCCA（53/97，54%）和pCCA（54/105，51%）亚组中都非常普遍。患有骨质减少的患者明显比没有骨质减少的患者年龄更大（71.1 [62 - 76.6]岁 vs. 61.3 [52.9 - 69.2]岁；< 0.001）。骨密度的改变在围手术期发病率方面未显示出显著的预后影响（曼-惠特尼U检验；综合并发症指数-CCI：34 [9 - 56] vs. 40 [21 - 72] = 0.185；iCCA： = 0.803；pCCA： = 0.165）。我们队列中的中位总生存期为19 [14 - 25]个月。与骨密度正常的患者相比，骨质减少的患者总生存期没有显著差异（对数秩检验 = 0.234）。
与我们之前在其他肿瘤患者队列中的观察结果相反，在我们这个接受CCA根治性手术的大型欧洲患者队列中，单纯的骨质减少对临床结局没有显著的负面影响。为了验证这些发现，有必要进行进一步的前瞻性研究。
