Casavilla F A, Marsh J W, Iwatsuki S, Todo S, Lee R G, Madariaga J R, Pinna A, Dvorchik I, Fung J J, Starzl T E
Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh Medical Center, PA 15213, USA.
J Am Coll Surg. 1997 Nov;185(5):429-36. doi: 10.1016/s1072-7515(97)00088-4.
Recent publications have questioned the role of orthotopic liver transplantation (OLT) in treating advanced or unresectable peripheral cholangiocarcinoma (Ch-Ca).
We reviewed our experience with Ch-Ca to determine survival rates, recurrence patterns, and risk factors in 54 patients who underwent either hepatic resection or OLT between 1981 and 1994. Liver transplantation was performed in patients with unresectable tumors (n = 12) and in those with advanced cirrhosis (n = 8). There were 33 women (61%) and 21 men (39%), with a mean age of 54.3 years. The median followup period was 6.8 years. Prognostic risk factors were analyzed by univariate and multivariate analyses.
Mortality within 30 days was 7.4%. Overall patient and tumor-free survival rates were 64% and 57% at 1 year, 34% and 34% at 3 years, and 26% and 27% at 5 years after operation. Thirty-two patients (59.3%) experienced tumor recurrence. Univariate analysis revealed that multiple tumors, bilobar tumor distribution, regional lymph node involvement, presence of metastasis, positive surgical margins, and advanced pTNM stages were significant negative predictors of both tumor-free and patient survival. Multivariate analysis revealed that positive margins, multiple tumors, and lymph node involvement were independently associated with poor prognosis. When patients with these three negative predictors were excluded, the patient survivals at 1, 3, and 5 years were 74%, 64%, and 62%, respectively.
Both hepatic resection and OLT are effective therapies for Ch-Ca when the tumor can be removed with adequate margins, the lesion is singular, and lymph nodes are not involved.
近期的出版物对原位肝移植（OLT）在治疗晚期或无法切除的周围型胆管癌（Ch-Ca）中的作用提出了质疑。
我们回顾了我们在Ch-Ca方面的经验，以确定1981年至1994年间接受肝切除或OLT的54例患者的生存率、复发模式和危险因素。对无法切除肿瘤的患者（n = 12）和晚期肝硬化患者（n = 8）进行了肝移植。有33名女性（61%）和21名男性（39%），平均年龄为54.3岁。中位随访期为6.8年。通过单因素和多因素分析对预后危险因素进行了分析。
30天内的死亡率为7.4%。术后1年、3年和5年的总体患者生存率和无瘤生存率分别为64%和57%、34%和34%、26%和27%。32例患者（59.3%）出现肿瘤复发。单因素分析显示，多发肿瘤、双叶肿瘤分布、区域淋巴结受累、转移的存在、手术切缘阳性和晚期pTNM分期是无瘤生存率和患者生存率的显著负性预测因素。多因素分析显示，切缘阳性、多发肿瘤和淋巴结受累与预后不良独立相关。当排除具有这三个负性预测因素的患者时，1年、3年和5年的患者生存率分别为74%、64%和62%。
当肿瘤能够在足够的切缘下切除、病变为单发且淋巴结未受累时，肝切除和OLT都是Ch-Ca的有效治疗方法。
