可切除肝门部胆管癌肝移植联合新辅助治疗与根治性肝切除的生存获益对比

A study on resectable hilar cholangiocarcinoma comparing neoadjuvant therapy combined with liver transplantation versus radical hepatectomy

目的比较肝移植联合新辅助治疗与根治性肝切除治疗可切除肝门部胆管癌的生存差异。方法回顾性分析天津市第一中心医院器官移植科2009年1月至2014年12月可手术切除的64例肝门部胆管癌患者资料,其中男性43例,女性21例,平均年龄61.2岁。其中行根治性肝切除术45例纳入肝切除组,肝移植联合新辅助治疗(体外放疗联合5-氟尿嘧啶静脉滴注、经导管腔内放疗、卡培他滨口服)19例纳入肝移植组。比较两组复发率和生存率。结果肝移植组术后1、3、5年累积生存率分别为89.5%、73.7%、63.2%,优于肝切除组80.0%、53.3%和35.6%。差异有统计学意义(P<0.05)。肝移植组术后肿瘤复发率31.6%(6/19),低于肝切除组60.0%(27/45),差异有统计学意义(P<0.05)。根据术后病理结果行亚组分析,无淋巴结转移(N0)且切缘阴性(R0)的患者,肝移植组(n=13)与肝切除组(n=29)累积生存率比较差异无统计学意义(P>0.05)。而区域淋巴结受侵(N1)R0切缘的患者,肝移植组(n=6)术后1、3、5年累积生存率分别为83.3%、66.7%、50.0%,优于肝切除组(n=14)64.3%、28.6%、14.3%,差异有统计学意义(P<0.05)。结论对于N0R0可切除的肝门部胆管癌患者,建议行肝切除;对于N1R0可切除的肝门部胆管癌患者,肝移植联合新辅助治疗方案比肝切除生存率更佳。

Objective To compare the treatment outcomes of neoadjoint therapy combined with liver transplantation versus radical hepatectomy for patients with surgically resectable hilar cholangiocarcinoma.Methods A retrospective study was performed on the data of 64 patients with resectable hilar cholangiocarcinoma operated from January 2009 to December 2014 at the Organ Transplantation Department of the First Central Hospital of Tianjin.There were 43 males and 21 females,with an average age of 61.2 years.There were 45 patients who underwent radical hepatectomy in the liver resection group,and 19 patients who underwent combined neoadjuvant therapy(radiotherapy combined with 5-fluorouracil intravenous drip,transcatheter lumen radiotherapy,capecitabine oral administration)and liver transplantation in the liver transplantation group.The recurrence rates and survival rate were compared between groups.Results The 1,3 and 5 years cumulative survival rates of the liver transplantation group were 89.5%,73.7%and 63.2%,respectively,which were significantly better than those of the liver resection group(80.0%,53.3%and 35.6%)(P<0.05).The postoperative tumor recurrence rate in the liver transplantation group was 31.6%(6/19),which was significantly lower than that in the liver resection group of 60.0%(27/45)(P<0.05).Subgroup analysis using postoperative pathological results showed the cumulative survival rates of patients without lymph node metastasis(N0)and those with negative resection margins(R0)were not significantly different between groups(P>0.05).However,for patients with regional lymph node invasion(N1)and with R0 resection margin,the cumulative survival rates at 1,3 and 5 years after liver transplantation were 83.3%,66.7%and 50.0%,respectively,which were significantly superior to the 64.3%,28.6%and 14.3%of the liver resection group(P<0.05).Conclusion Hepatectomy is recommended for patients with N0 R0 resectable hilar cholangiocarcinoma.For patients with hilar cholangiocarcinoma with marginally resectable N1R0,neoadjuvant therapy combined with liver transplantation resulted in significantly better long-term overall survival than resection.