Abstract
Long-term survival following hepatectomy for intrahepatic cholangiocarcinoma has been poor, and specific factors influencing survival are unclear. In a retrospective study we sought to determine prognostic factors related to survival in these patients. In 28 patients who underwent hepatic resection for intrahepatic cholangiocarcinoma, we investigated the relations of several histologic factors to patient survival by univariate and multivariate analyses. No deaths occurred during the first 30 days. Median and mean survival times following hepatectomy were 409 and 935 days, respectively. The respective survival rates at 1, 3, and 5 years were 57%, 27%, and 27%. Resection margin status, intrahepatic metastasis, lymph node involvement, and lymphatic invasion were significant predictors of outcome. In a multivariate analysis using the Cox proportional hazards model, only lymphatic invasion independently predicted survival. Curative resection with clear margins was found to prolong survival after surgery. Hepatectomy for intrahepatic cholangiocarcinoma without lymphatic invasion offers hope for long-term survival.
Résumé
Alors que la survie à long terme après hépatectomie pour cholangiocarcinome intrahépatique est médiocre, les facteurs spécifiques influençant la survie ne sont pas clairement connus. Dans une étude rétrospective, nous avons essayé de déterminer les facteurs pronostiques en rapport avec la survie chez ces patients. Chez 28 patients ayant eu une résection hépatique pour cholangiocarcinome intrahépatique, nous avons réalisé une analyse uni- et multifactorielle pour étudier les rapports entre plusieurs facteurs histologiques et la survie. Aucune mortalité n’a été enregistrée pendant les 30 premiers jours. La survie médiane et moyenne après hépatectomie ont été, respectivement, de 409 et de 935 jours. Le taux de survie à 1, 3 et 5 ans ont été, respectivement, de 57%, de 27% et de 27%. L’état des marges de résection, les métastases intrahépatiques et l’envahissement ganglionnaire étaient des facteurs pronostiques significatifs. D’après analyse multifactorielle selon Cox, seul l’envahissement ganglionnaire était un facteur indépendant de survie. La résection avec clairance d’une marge de sécurité prolonge la survie. L’hépatectomie pour cholangiocarcinome intrahépatique sans envahissement ganglionnaire offre un espoir de survie à long terme.
es|Resumen
Aunque la supervivencia a largo plazo tras hepatectomía por colangiocarcinoma intrahepático es escasa, no están claros los factores capaces de influir en la misma. En este estudio retrospectivo intentamos determinar los factores pronósticos relacionados con la supervivencia de estos pacientes. En 28 enfermos que sufrieron una resección hepática por colangiocarcinoma intrahepático, investigamos mediante análisis uni y multivariable la relación de diversos hallazgos histológicos con su supervivencia. Ningún paciente falleció en los primeros 30 días. La mediana y la media del tiempo de supervivencia tras hepatectomía fueron 409 y 935 días. La tasa de supervivencia a 1, 3 y 5 años fue 57%, 27% y 27%. Factores predictives significativos para los resultados fueron la infiltración o no de los márgenes de resección, las metástasis intrahepáticas, la afectación de ganglios linfáticos y la invasión linfática. En el análisis multivariante, utilizando el modelo de Cox, sólo la invasión linfática resultó ser un factor predictivo independiente, por lo que a la supervivencia se refiere. Resecciones curativas con limpios márgenes prolongaron la supervivencia tras cirugía. La hepatectomía por colangiocarcinoma intrahepático sin invasión linfática constituye un pronóstico favorable, por lo que a una prolongada supervivencia se refiere.
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Uenishi, T., Hirohashi, K., Kubo, S. et al. Histologic factors affecting prognosis following hepatectomy for intrahepatic cholangiocarcinoma. World J. Surg. 25, 865–869 (2001). https://doi.org/10.1007/s00268-001-0042-3
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DOI: https://doi.org/10.1007/s00268-001-0042-3