Iwatsuki S, Todo S, Marsh J W, Madariaga J R, Lee R G, 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. 1998 Oct;187(4):358-64. doi: 10.1016/s1072-7515(98)00207-5.
Because of the rarity of hilar cholangiocarcinoma, its prognostic risk factors have not been sufficiently analyzed. This retrospective study was undertaken to evaluate various pathologic risk factors which influenced survival after curative hepatic resection or transplantation.
Between 1981 and 1996, 72 patients (43 males and 29 females) with hilar cholangiocarcinoma underwent hepatic resection (34 patients) or transplantation (38 patients) with curative intent. Medical records and pathologic specimens were reviewed to examine the various prognostic risk factors. Survival was calculated by the method of Kaplan-Meier using the log rank test with adjustment for the type of operation. Survival statistics were calculated first for each kind of treatment separately, and then combined for the calculation of the final significance value.
Survival rates for 1, 3, and 5 years after hepatic resection were 74%, 34%, and 9%, respectively, and those after transplantation were 60%, 32%, and 25%, respectively. Univariate analysis revealed that T-3, positive lymph nodes, positive surgical margins, and pTNM stage III and IV were statistically significant poor prognostic factors. Multivariate analysis revealed that pTNM stage 0, I, and II, negative lymph node, and negative surgical margins were statistically significant good prognostic factors. For the patients in pTNM stage 0-II with negative surgical margins, 1-, 3-, and 5-year survivals were 80%, 73%, and 73%, respectively. For patients in pTNM stage IV-A with negative lymph nodes and surgical margins, 1-, 3-, and 5-year survivals were 66%, 37%, and 37%, respectively.
Satisfactory longterm survivals can be obtained by curative surgery for hilar cholangiocarcinoma either with hepatic resection or liver transplantation. Redefining pTNM stage III and IV-A is proposed to better define prognosis.
由于肝门部胆管癌较为罕见，其预后危险因素尚未得到充分分析。本回顾性研究旨在评估影响根治性肝切除或肝移植术后生存的各种病理危险因素。
1981年至1996年间，72例肝门部胆管癌患者（43例男性，29例女性）接受了根治性肝切除（34例）或肝移植（共38例）。回顾病历和病理标本以检查各种预后危险因素。采用Kaplan-Meier法计算生存率，并使用对数秩检验对手术类型进行校正。首先分别计算每种治疗方法的生存统计量，然后合并计算最终的显著性值。
肝切除术后1年、3年和5年生存率分别为74%、34%和9%，肝移植术后分别为60%、32%和25%。单因素分析显示，T-3、淋巴结阳性、手术切缘阳性以及pTNM分期III和IV是具有统计学意义的不良预后因素。多因素分析显示，pTNM分期0、I和II、淋巴结阴性以及手术切缘阴性是具有统计学意义的良好预后因素。对于手术切缘阴性的pTNM分期0-II期患者，1年、3年和5年生存率分别为80%、73%和73%。对于淋巴结和手术切缘阴性的pTNM分期IV-A期患者，1年、3年和5年生存率分别为66%、37%和37%。
肝门部胆管癌通过根治性手术（肝切除或肝移植）可获得满意的长期生存。建议重新定义pTNM分期III和IV-A期以更好地明确预后。
