| 临床与病理评估无淋巴结转移的肝内胆管癌患者术后预后对比 |
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| 引用本文： | 林谦益,简志威,彭竞源,林义乐,劳向明.临床与病理评估无淋巴结转移的肝内胆管癌患者术后预后对比[J].中国肿瘤临床,2021,48(14):703-710. |
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| 作者姓名： | 林谦益 简志威 彭竞源 林义乐 劳向明 |
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| 作者单位： | 中山大学肿瘤防治中心胰胆外科，华南肿瘤学国家重点实验室，肿瘤医学协同创新中心 （广州市510060） |
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| 摘 要： | 目的 比较肝内胆管癌（intrahepatic cholangiocarcinoma，ICC）中临床评估无淋巴结转移且未行淋巴结切除（clinically node-negative without lymphadenectomy，cN0/LND-）和病理评估无淋巴结转移（pathologically node-negative，pN0）患者的术后生存差异。从预后的角度探讨在ICC中cN0能否作为pN0的替代指标。 方法 检索SEER数据库2004～2017年行部分肝切除术且无远处转移的ICC患者。经倾向性评分匹配（propensity-score matching，PSM）后分为下述3个部分进行生存比较:cN0/LND- vs. pN0淋巴结切除数（harvested lymph nodes，HLN）>0枚]；cN0/LND- vs. pN0（HLN≥6枚）；pN0（HLN≥6枚）vs. pN0（HLN<6枚）。 结果 PSM后，pN0组（HLN>0枚）总生存时间（overall survival，OS）显著长于cN0/LND-组中位OS（median OS，mOS）:54个月 vs. 44个月，P=0.038], 多因素分析结果提示pN0（HLN>0枚）为预后良好的独立相关因素（P<0.05）。并且HLN≥6枚淋巴结的pN0患者mOS比cN0/LND-患者更长（72个月 vs. 44个月，P=0.037）。对T分期进行分层分析，结果显示无论是T1/2期或T3/4期的pN0（HLN≥6枚）患者的mOS均长于相应的cN0/LND-患者。此外，pN0（HLN≥6枚）患者的mOS趋向于比pN0（HLN<6枚）患者更长（72个月 vs. 50个月，P=0.064）。 结论 ICC术后pN0患者的OS优于cN0/LND-患者，且HLN≥6枚淋巴结的pN0患者比cN0/LND-患者预后更好。因此，从预后的角度看，在ICC中cN0并非pN0的理想替代指标。对于临床评估无淋巴结转移的ICC患者仍建议常规行淋巴结切除/清扫。
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| 关 键 词： | 肝内胆管癌 手术治疗 临床评估无淋巴结转移 病理评估无淋巴结转移 预后 |
| 收稿时间： | 2021-04-28 |
Comparison of prognosis between clinically node-negative and pathologically node-negative intrahepatic cholangiocarcinoma after hepatectomy |
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| Affiliation: | Department of Pancreaticobiliary Surgery, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou 510060, China |
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| Abstract: | Objective To compare the overall survival (OS) of patients with clinically node-negative without lymphadenectomy (cN0/LND-)] and pathologically node-negative (pN0) intrahepatic cholangiocarcinoma (ICC) after hepatectomy and investigate whether cN0 status could be considered a reliable substitute for pN0 status when determining the prognosis of ICC patients. Methods Patients with ICC without distant metastasis who underwent hepatectomy, registered in the Surveillance Epidemiology and End Result (SEER) database, between 2004 and 2017 were retrospectively enrolled. Propensity-score matching (PSM) was performed to control selection bias of the following three pairs of groups: cN0/LND- vs. pN0 number of harvested lymph nodes (HLN)>0]; cN0/LND- vs. pN0 (number of HLN≥6), and pN0 (number of HLN≥6) vs. pN0 (number of HLN<6). OS was analyzed using the Kaplan–Meier method and Cox proportional hazards regression. Results After PSM, the pN0 group (number of HLN>0) showed a significantly longer median OS than the cN0/LND-group (54 vs. 44 months, P=0.038). Multivariate analyses showed that pN0 status (number of HLN>0) was an independent prognostic factor for OS (P<0.05). Furthermore, pN0 patients with at least six HLN showed a significantly longer median OS than cN0/LND- patients (72 vs. 44 months, P=0.037), irrespective of T stage. The difference in median OS between the pN0 (number of HLN≥6) and pN0 (number of HLN<6) groups was marginally significant (72 vs. 50 months, P=0.064). Conclusions pN0 patients with ICC who underwent hepatectomy showed better OS than cN0/LND- patients. Especially, pN0 patients with at least 6 HLN showed much longer OS than cN0/LND- patients. Thus, in patients with ICC, cN0 status should not be considered a reliable substitute for pN0 status when determining prognosis. Routine lymphadenectomy is recommended even for patients with clinically node-negative ICC. |
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