Intrahepatic Cholangiocarcinoma: An International Multi-Institutional Analysis of Prognostic Factors and Lymph Node Assessment

被引：685

作者：

de Jong, Mechteld C. ^{[1
]}

Nathan, Hari ^{[1
]}

Sotiropoulos, Georgios C. ^{[2
]}

Paul, Andreas ^{[2
]}

Alexandrescu, Sorin ^{[3
]}

Marques, Hugo ^{[4
]}

Pulitano, Carlo ^{[5
]}

Barroso, Eduardo ^{[4
]}

Clary, Bryan M. ^{[6
]}

Aldrighetti, Luca ^{[5
]}

Ferrone, Cristina R. ^{[7
]}

Zhu, Andrew X. ^{[7
]}

Bauer, Todd W. ^{[8
]}

Walters, Dustin M. ^{[8
]}

Gamblin, T. Clark ^{[9
]}

Nguyen, Kevin T. ^{[9
]}

Turley, Ryan ^{[6
]}

Popescu, Irinel ^{[3
]}

Hubert, Catherine ^{[10
]}

Meyer, Stephanie ^{[11
]}

Schulick, Richard D. ^{[1
]}

Choti, Michael A. ^{[1
]}

Gigot, Jean-Francois ^{[10
]}

Mentha, Gilles ^{[11
]}

Pawlik, Timothy M. ^{[1
]}

机构：

[1] Johns Hopkins Univ Sch Med, Baltimore, MD USA

[2] Univ Hosp Essen, Essen, Germany

[3] Inst Digest Dis & Liver Transplantat Fundeni, Bucharest, Romania

[4] Curry Cabral Hosp, Lisbon, Portugal

[5] Univ Milan, Osped San Raffaele, I-20127 Milan, Italy

[6] Duke Med Ctr, Durham, NC USA

[7] Massachusetts Gen Hosp, Boston, MA 02114 USA

[8] Univ Virginia, Charlottesville, VA USA

[9] Univ Pittsburgh, Pittsburgh, PA USA

[10] Clin Univ St Luc, B-1200 Brussels, Belgium

[11] Hop Univ Geneve, Geneva, Switzerland

来源：

JOURNAL OF CLINICAL ONCOLOGY | 2011年 / 29卷 / 23期

关键词：

STAGING SYSTEM; EXPERIENCE; MANAGEMENT; RESECTION; SURVIVAL;

D O I：

10.1200/JCO.2011.35.6519

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 [肿瘤学];

摘要：

Purpose To identify factors associated with outcome after surgical management of intrahepatic cholangio-carcinoma (ICC) and examine the impact of lymph node (LN) assessment on survival. Patients and Methods From an international multi-institutional database, 449 patients who underwent surgery for ICC between 1973 and 2010 were identified. Clinical and pathologic data were evaluated using uni- and multivariate analyses. Results Median tumor size was 6.5 cm. Most patients had a solitary tumor (73%) and no vascular invasion (69%). Median survival was 27 months, and 5-year survival was 31%. Factors associated with adverse prognosis included positive margin status (hazard ratio [HR], 2.20; P < .001), multiple lesions (HR, 1.80; P = .001), and vascular invasion (HR, 1.59; P = .015). Tumor size was not a prognostic factor (HR, 1.03; P = .23). Patients were stratified using the American Joint Committee on Cancer/International Union Against Cancer T1, T2a, and T2b categories (seventh edition) in a discrete step-wise fashion (P < .001). Lymphadenectomy was performed in 248 patients (55%); 74 of these (30%) had LN metastasis. LN metastasis was associated with worse outcome (median survival: N0, 30 months v N1, 24 months; P = .03). Although patients with no LN metastasis were able to be stratified by tumor number and vascular invasion (N0; P < .001), among patients with N1 disease, multiple tumors and vascular invasion, either alone or together, failed to discriminate patients into discrete prognostic groups (P = .34). Conclusion Although tumor size provides no prognostic information, tumor number, vascular invasion, and LN metastasis were associated with survival. N1 status adversely affected overall survival and also influenced the relative effect of tumor number and vascular invasion on prognosis. Lymphadenectomy should be strongly considered for ICC, because up to 30% of patients will have LN metastasis.

引用

页码：3140 / 3145

页数：6

共 22 条

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