外科理论与实践

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2021 , Vol. 26 >Issue 02: 130 - 137

DOI: https://doi.org/10.16139/j.1007-9610.2021.02.009

论著

切缘宽度对单发肝内胆管癌预后影响的多中心研究

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  • 1.福建医科大学孟超肝胆医院肝胆外科,福建 福州 350025
    2.海军军医大学东方肝胆外科医院 肝脏外科,上海 200433
    3.东南大学附属中大医院肝胆胰外科,江苏 南京 210009
    4.浙江大学 医学院附属第二医院肝胆胰外科,浙江 杭州 310009
    5.陆军军医大学西南医院胆道外科,重庆 400038
    6.中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京 100021
    7.华中科技大学同济医学院附属同济医院胆胰外科,湖北 武汉 430030
    8.首都医科大学附属北京友谊医院普外科,北京 100050
    9.四川大学华西医院胆道外科,四川 成都 610041
    10.上海交通大学医学院附属仁济医院胆胰外科,上海 200127
    11.首都医科大学宣武医院普外科,北京 100053
    12.川北医学院附属医院肝胆外科,四川 南充 617000
    13.首都医科大学附属北京天坛医院普外科,北京 100070

收稿日期: 2021-01-26

  网络出版日期: 2022-07-27

基金资助

福州市科技局项目(2020-WS-92)

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Effect of surgical margin width on prognosis in patients with single intrahepatic cholangiocarcinoma from a multicenter study

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  • 1. Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital, Fujian Medical University, Fujian Fuzhou 350025, China
    2. Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, Navy Medical University, Shanghai 200433, China
    3. Department of Hepatopancreatobiliary Surgery, Zhongda Hospital, Southeast University, Jiangsu Nanjing 210009, China
    4. Department of Hepatopancreatobiliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310009, China
    5. Department of Biliary Surgery, Southwest Hospital, Army Medical University, Chongqing 400038, China
    6. Department of Hepatobi-liary Surgery, Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
    7. Department of Biliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Wuhan 430030, China
    8. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
    9. Department of Biliary Surgery, West China Hospital, Sichuan University, Sichuan Chengdu 610041, China
    10. Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    11. Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
    12. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Sichuan Nanchong 617000, China
    13. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received date: 2021-01-26

  Online published: 2022-07-27

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摘要

目的：分析宽切缘肝切除术对单发肝内胆管癌（intrahepatic cholangiocarcinoma, ICC）病人预后的影响,探讨微血管侵犯对宽、窄切缘治疗的影响。方法：回顾性分析2011年12月至2017年12月国内13家医疗中心行根治性切除治疗的302例单发ICC病人临床病理资料。根据手术切缘宽度分为宽切缘组（切缘≥1 cm）126例（41.7%）和窄切缘组（切缘<1 cm）176例（58.3%）,利用Kaplan-Meier分析比较两组总生存率和无病生存率。亚组分析比较宽、窄切缘对不同微血管侵犯状态病人预后的差异。结果：经1∶1 倾向评分匹配（propensity score matching, PSM）后,宽切缘组和窄切缘组分别获得83例,两组基线资料差异均无统计学意义（P>0.05）。PSM前宽切缘组无病生存率显著高于窄切缘组（P=0.005）,而总生存率差异无统计学意义（P=0.053）。PSM后宽切缘组总生存率和无病生存率均显著高于窄切缘组（P<0.05）。微血管侵犯阳性组行不同切缘肝切除手术,术后总体生存率和无病生存率差异均无统计学意义（P>0.05）。微血管侵犯阴性组宽切缘肝切除病人较窄切缘肝切除病人,术后总生存率和无病生存率均明显升高,差异均有统计学意义（P<0.05）。结论：宽切缘肝切除术可改善单发ICC病人总体生存和无病生存,但合并微血管侵犯时,宽切缘并不能改善预后。

关键词： 肝内胆管癌; 切缘宽度; 微血管侵犯; 倾向评分匹配; 多中心

本文引用格式

刘红枝, 林自国, 黄建龙, 周伟平, 程张军, 楼健颖, 郑树国, 毕新宇, 王剑明, 郭伟, 李富宇, 王坚, 郑亚民, 李敬东, 程石, 刘景丰, 曾永毅 . 切缘宽度对单发肝内胆管癌预后影响的多中心研究[J]. 外科理论与实践, 2021 , 26(02) : 130 -137 . DOI: 10.16139/j.1007-9610.2021.02.009

Abstract

Objective To investigate the effect of wide surgical margin on the prognosis of patients with single intrahepatic cholangiocarcinoma (ICC) undergoing hepatectomy and the effect of microvascular invasion (MVI) on the treatment of hepatectomy with both wide surgical margin and narrow surgical margin. Methods From December 2011 to December 2017, the clinicopathological data of 302 patients with single ICC who underwent radical resection were retrospectively studied in 13 medical centers. According to the width of surgical margin, there were 126 patients (41.7%) in wide surgical margin group (≥1 cm) and 176 patients (58.3%) in narrow surgical margin group (<1 cm). Overall survival rate and disease-free survival rate of two groups were compared by Kaplan-Meier analysis. Subgroup analysis was conducted to compare the differences in prognosis of patients with different MVI. Results Using 1∶1 propensity score matching(PSM), 83 patients were in both wide surgical margin group and narrow surgical margin group, and there was no statistical difference in baseline data between two groups (all P>0.05). Disease-free survival rate in wide surgical margin group before PSM was significantly higher than that in narrow surgical margin group (P=0.005), while overall survival rate showed no statistically significant difference (P=0.053). After PSM, both overall survival rate and disease-free survival rate in wide surgical margin group were significantly higher than those in narrow surgical margin group (P<0.05). There was no statistically significant difference in both overall survival rate and disease-free survival rate among patients with MVI positive after liver resection with different surgical margins (P>0.05). In MVI negative group, however both overall survival rate and disease-free survival rate were significantly higher in the patients with wide surgical margin hepatectomy than in those with narrow surgical margin (P<0.05). Conclusions Wide surgical margin in hepatectomy can increase overall survival and disease-free survival in patients with single ICC, but does not improve prognosis when patients with MVI.

Key words： Intrahepatic cholangiocarcinoma; Surgical margin width; Microvascular invasion; Propensity score matching; Multicenter

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