切缘宽度对单发肝内胆管癌预后影响的多中心研究

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

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。

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 December2017,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.