肝切除切缘的距离对肝内胆管癌伴乙型肝炎肝硬化预后的影响

The Impact of Surgical Margin in Intrahepatic Cholangiocarcinomawith Hepatitis B Virus-related Cirrhosis After Hepatectomy

目的分析肝切除手术切缘的距离对肝内胆管癌伴乙型肝炎肝硬化患者的近期和远期预后的影响。方法回顾性分析东方肝胆外科医院306例ICC伴乙型肝炎肝硬化肝切除患者的临床病理资料。应用Kaplan-Meier法描绘无复发生存(recurrent free survival,RFS)和整体生存(overall survival,OS)曲线,Cox回归模型分析影响其预后的因素。结果 R1组患者39例(12.7%),阴性切缘组(R0)中,≥10 mm为宽切缘组87例和1~9 mm为窄切缘组180例。随访期间,209例(68.3%)患者出现复发。总体的中位和5年的RFS和OS分别为13.8月,24%和21.3月,28%。R1切除提示较差的RFS(P=0.002)和OS(P=0.006)。窄切缘相对于宽切缘提示更低的RFS(P=0.025),而OS(P=0.254)无差别。结论 R1切除是肝内胆管癌伴乙型肝炎肝硬化的患者长期预后的独立危险因素。推荐肝切除时尽可能保证大于10 mm的手术切缘改善预后。

Objective To evaluate the influence of the surgical margin on short-andlong-termprognosisafter resection of intra- hepatic cholangiocarcinoma （ICC） with hepatitis B virus （HBV） -related cirrhosis. Methods A total of 306 ICC with HBV-related cirrhosis patients who underwent hepatectomy between July 2004 and June 2013 at the Eastern Hepatobiliary Surgery Hospital were en- rolled in the study. Survival curves were depicted using the Kaplan-Meier method and compared using the log-rank test. Cox regression analysis was used for multivariate analyses. Results Marginstatus was positive（ R1 ） in 39 （ 12.7% ） patients, amongpatientswhounder- wenta negative resection margin（ R0）, margin width was further divided into narrow margin （ 〈 10 mm） inl80 patients and wide mar- gin （≥ 10 mm） in 87patients. During follow-upperiod, 209 patients （68. 3% ） experiencedtumorrelapse. The median and 5-years of RFS and OS werel3.8 months, 24% and 21.3 months, 28%, respectively. Patientswho had an RI resection had an inferior RFS （P = 0. 002） and OS （P = 0. 006）. Narrow margin also had a shorter RFS （ P = 0. 025 ） except OS （ P = 0. 254） compared to wide mar- gin. Conclusions For patients undergoing resection of ICCwith HBV-related cirrhosis, R1 margin statushad an unfavorable prognosis outcome. Surgeons should strive to achieve at least a 10 mm margin when resecting ICC in order to optimize long-term outcomes.