Conversion surgery after gemcitabine and cisplatin plus durvalumab for advanced intrahepatic cholangiocarcinoma:A case report

BACKGROUND The combination of immune checkpoint inhibitors and chemotherapy has shown promising results for the treatment of advanced biliary tract cancer(BTC).Based on the results of the TOPAZ-1 trial,a gemcitabine and cisplatin plus durvalumab(GCD)regimen was recently approved as first-line therapy for patients with advanced BTC.However,post-GCD conversion surgery has not been previously studied.Herein,we describe a case of advanced intrahepatic cholangiocarcinoma(ICC)successfully treated with radical surgery after GCD.CASE SUMMARY A 65-year-old female diagnosed with advanced ICC with periductal infiltration into the hepatic hilum underwent eight cycles of GCD,followed by durvalumab maintenance treatment,with mild adverse events.Partial response was obtained.Subsequently,a conversion surgery with extended left hepatectomy and bile duct resection was performed.The resection margins were negative,and the pathological diagnosis was compatible with small duct type ICC.The patient remained disease-free for 8 months without adjuvant chemotherapy.CONCLUSION We describe the case of a patient who received successful conversion surgery after GCD treatment for advanced ICC.

Distinct Immune Signatures in Peripheral Blood Predict Chemosensitivity in Intrahepatic Cholangiocarcinoma Patients

Intrahepatic cholangiocarcinoma(ICC)is the second most common liver cancer.Chemotherapy remains the main therapeutic strategy for advanced ICC patients,but chemosensitivity varies individually.Here,we applied cytometry by time-of-flight(CyTOF)to establish the immune profile of peripheral blood mononuclear cells(PBMCs)on the single-cell level at indicated time points before,during,and after chemotherapy.Multiplex immunofluorescence staining was applied to examine the spatial distribution of certain immune clusters.Tissue microarrays(TMAs)were used for prognostic evaluation.A total of 20 ICC patients treated with gemcitabine(GEM)were enrolled in our study,including eight cases with good response(R)and 12 cases with non-response(NR).Tremendous changes in PBMC composition,including an increased level of CD4/CD8 double-positive T cells(DPT),were observed after chemotherapy.Patients with higher level of CD4^(+)CD45RO^(+)CXCR3^(+)T cells before treatment had a favorable response to chemotherapy.Our study identified a positive correlation between the percentage of T cell subpopulations and clinical response after chemotherapy,which suggests that it is practical to predict the potential response before treatment by evaluating the proportions of the cell population in PBMCs.

Cystic Degeneration of Peripheral Intrahepatic Cholangiocarcinoma: An Atypical Presentation

Cholangiocarcinomas are primary malignant tumors of the liver that arises from the epithelium lining the small intra and extrahepatic bile ducts, and has numerous histologic types and growth patterns. At computed tomography (CT) and magnetic ressonance (MR), it has various appearences which motivated the present study;we present a case within an atypical presentation. The objective is to show the variety of differential diagnoses before an atypical aspect and the importance of the imaging methods for the diagnosis. Cholangiocarcinoma is still an uncommon neoplasm, and CT and MR are crucial for accurate diagnosis and for differentiation from other hepatic tumorous and nontumorous lesions.

Surgery and chemotherapy for intrahepatic cholangiocarcinoma

Cholangiocarcinoma, arising from bile duct epithelium, is categorized into intrahepatic cholangiocarcinoma (ICC) and extrahepatic cholangiocarcinoma (ECC), including hilarcholangiocarcinoma. Recently, there has been a worldwide increase in the incidence and mortality from ICC. Complete surgical resection is the only approach to cure the patients with ICC. However, locoregional extension of these tumors is usually advanced with intrahepatic and lymph-node metastases at the time of diagnosis. Resectability rates are quite low and variable (18%-70%). The five-year survival rate after surgical resection was reported to be 20%-40%. Median survival time after ICC resection was 12-37.4 mo. Only a small number of ICC cases, accompanied with ECC, gall bladder carcinoma, and ampullary carcinoma, have been reported in the studies of chemotherapy due to the rarity of the disease. However, in some reports, significant anti-cancer effects were achieved with a response rate of up to 40% and a median survival ofone year. Although recurrence rate after hepatectomy is high for the patients with ICC, the residual liver and the lung are the main sites of recurrence after tentative curative surgical resection. Several patients in our study had a long-term survival with repeated surgery and chemotherapy. Repeated surgery, combined with new effective regimens of chemotherapy, could benef it the survival of ICC patients.

Clinicopathological and prognostic analysis of 429 patients with intrahepatic cholangiocarcinoma

AIM:To understand the clinicopathological characteristics and treatment selections and improve survival and provide valuable information for patients with intrahepatic cholangiocarcinoma(ICC). METHODS:We retrospectively evaluated 5311 liver cancer patients who received resection between October 1999 and December 2003.Of these,429(8.1%)patients were diagnosed with ICC,and their clinicopathological, surgical,and survival characteristics were analyzed. RESULTS:Upper abdominal discomfort or pain(65.0%), no symptoms(12.1%),and hypodynamia(8.2%)were the major causes for medical attention.Laboratory tests showed 198(46.4%)patients were HBsAg positive, 90(21.3%)hadα-fetoprotein>20μg/L,50(11.9%) carcinoembryonic antigen>10μg/L,and 242(57.5%) carbohydrate antigen 19-9(CA19-9)>37 U/mL.Survival data was available for 329(76.7%)patients and their mean survival time was 12.4 mo.The overall survival of the patients with R0,R1 resection and punching exploration were 18.3,6.6 and 5.6 mo,respectively. Additionally,CA19-9>37 U/mL was associated with lymph node metastases,but inversely associated withcirrhosis.Multivariate analysis indicated that radical resection,lymph node metastases,macroscopic tumor thrombi and size,and CA19-9 were associated with prognosis. CONCLUSION:Surgical radical resection is still the most effective means to cure ICC.Certain laboratory tests(such as CA19-9)can effectively predict the survival of the patients with ICC.

Clinicopathologic features, diagnosis and surgical treatment of intrahepatic cholangiocarcinoma in 104 patients

BACKGROUND: The outcome of surgical treatment of pa- tients with intrahepatic cholangiocarcinoma (ICC) is poor. This study was designed to analyze the relationship between clinicopathologic features and the survival time after opera- tion. METHODS: The operation was performed in 104 patients with mass-forming type ICC at our hospital between No- vember 1996 and May 2000. Seventy-nine patients (76.0%) were followed up successfully. Sixteen clinicopathological variables including age, sex, history of chronic liver di- sease , HBsAg, operation, adjuvant therapy, ascites, lymph node metastasis, invasion of adjacent organs, tumor size, necrosis of tumor, envelope, intrahepatic metastasis, Inter- national Union Against Cancer (UICC) TNM staging, his- tology, and cirrhosis were selected for univariate and multi- variate analyses to evaluate their influence on the prognosis. RESULTS: The accumulative 1-, 3-, 5-year survival rates of the 79 patients were 49.4%, 17.3%, 9.6% respectively. Univariate analysis revealed that sex (P=0.0221), HBsAg (P=0.0115), operation (P=0.0042), adjuvant therapy (P= 0.0389), ascites (P=0.0001), invasion (P=0.0220), intra- hepatic metastasis (P=0.0000) and TNM stage (P= 0.0001) were related to survival time. Multivariate analysis revealed that HBsAg, ascites and TNM stage were signifi- cantly related to prognosis. CONCLUSION: Early diagnosis and treatment and major hepatectomy are essential to improving the results of surgi- cal treatment of ICC patients.

Intrahepatic cholangiocarcinoma: Introducing the preoperative prediction score based on preoperative imaging

Background: Intrahepatic cholangiocarcinoma(ICC) still has a poor long-term outcome, even after complete resection. We investigated different parameters gathered in preoperative imaging and analyzed their influence on resectability, recurrence, and survival. Methods: All patients who underwent exploration due to ICC between January 2008 and June 2018 were analyzed retrospectively. Kaplan-Meier model, log-rank test and Cox regression were used. Results: Out of 184 patients, 135(73.4%) underwent curative intended resection. Median overall survival(OS) was 22.2 months with a consecutive 1-, 3-and 5-year OS of 73%, 29%, and 17%. Median recurrencefree survival(RFS) was 9.3 months with a consecutive 1-, 3-and 5-year RFS of 36%, 15%, and 11%. Site of tumor, parenchymal localization, tumor configuration/dissemination, and estimated tumor volume had significant influence on resectability. Univariate analyses showed that site of tumor, tumor configuration/dissemination, number of nodules, and estimated tumor volume had predictive values for OS and RFS. Together with tumor size the preoperative prediction(POP) score was created showing significance for OS and RFS(all P<0.001). In multivariate analysis, POP score(HR=1.779;95% CI: 1.26 8-2.4 95;P=0.001), T stage(HR=1.255;95% CI: 1.040-1.514;P=0.018) and N stage(HR=1.334;95% CI: 1.081-1.645;P=0.007) were the independent predictors for OS. For RFS, POP score(HR=1.733;95% CI: 1.30 0-2.311;P<0.0 01) and M stage(HR=3.036;95% CI: 1.376-6.697;P=0.006) were the independent predictors. Conclusions: The POP score showed to have a highly significant influence on OS and RFS. The score is easy to assess through preoperative imaging. For patients in the high risk group at least staging laparoscopy or preoperative chemotherapy should be evaluated, because they showed equal outcome compared to the irresectable group.

AJCC分期、术前PNI及不同淋巴结清扫方式与接受根治术治疗的ICC患者预后结局的关系

目的探讨第8版美国癌症联合委员会(AJCC)分期、术前预后营养指数(PNI)及不同淋巴结清扫方式与接受根治术治疗的肝内胆管细胞癌(ICC)患者预后结局的关系。方法选取本院2019年1月—2021年1月收治的105例ICC患者进行回顾性分析与病例对照研究相结合的方式进行研究,所有患者均接受肿瘤根治术治疗,其中59例患者术中采用整块融合清扫方式清扫淋巴结(A组)、另外46例患者术中采用传统常规的淋巴结清扫方式(B组),对两组患者随访1年观察生存率及生存时间进行比较;统计不同预后结局患者的AJCC分期、PNI及一般临床病理学参数,采用Logistic回归模型分析影响患者预后结局的关键因素。结果A组患者18个月随访后生存率为84.75%,B组为67.39%,A组显著高于B组,差异具有统计学意义(P<0.05);A组患者的生存时间长于B组患者,差异具有统计学意义(Log Rank(Mantel-Cox)=4.994,P=0.025)。死亡组患者T分期中≥T2期、N分期中N1分期、TNM分期中≥Ⅱ期、PNI指标<45.0的患者占比均显著高于生存组,差异具有统计学意义(P<0.05)。Logistic回归模型结果显示,TBIL≥20.0μmol/L、肿瘤数目多发、发生血管侵犯、手术中输血、N1分期、TNM分期≥Ⅱ期、PNI指标<45.0、常规淋巴结清扫方式是ICC患者不良预后结局的独立危险因素(P<0.05)。结论根据ICC患者的AJCC分期、术前PNI水平可以初步评估患者根治术后的预后结局,根治术中采取整块融合清扫方式清扫淋巴结有利于延长患者的生存时间。

基于倾向性评分匹配的腹腔镜与开腹手术治疗肝内胆管癌疗效的初步分析

目的初步分析腹腔镜手术与开腹手术治疗肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)的疗效。方法回顾性分析我科2010年9月~2023年3月84例ICC接受手术治疗的临床资料,腹腔镜组45例,开腹组39例,通过倾向性评分匹配,最终34对数据成功匹配,比较2组手术时间、术中出血量、清扫≥6枚淋巴结比例、R0切除率、并发症、术后住院时间、生存率及复发等。结果腹腔镜组术中出血量明显少于开腹组(中位数:250 ml vs.750 ml,Z=-3.406,P=0.001);腹腔镜组清扫≥6枚淋巴结比例与开腹组比较差异无统计学意义(5.9%vs.17.6%,χ^(2)=1.275,P=0.259);腹腔镜组与开腹组R0切除率差异无显著性[88.2%(30/34)vs.82.4%(28/34),χ^(2)=0.469,P=0.493]。腹腔镜组总并发症发生率17.6%(6/34),显著低于开腹组47.1%(16/34)(χ^(2)=6.719,P=0.010);2组严重并发症率均为2.9%(χ^(2)=0.000,P=1.000)。腹腔镜组术后住院时间明显缩短(中位数:7 d vs.10 d,Z=-3.021,P=0.003)。腹腔镜组中位总生存期60.6月,明显长于开腹组15.9月(log-rank χ^(2)=5.788,P=0.016);腹腔镜组中位无复发生存期26.4月,明显长于开腹组7.6月(log-rank χ^(2)=4.532,P=0.033)。结论腹腔镜肝切除术治疗ICC具有出血量少、并发症发生率低、术后住院时间短、生存期延长等优势,R0切除率、充分淋巴结清扫率与开腹手术相当。

射频消融与外科手术在富动脉血供肿块型肝内胆管癌中的疗效对比

目的探讨射频消融与外科手术在富动脉血供肿块型肝内胆管癌(IMCC)治疗中的效果差异。方法回顾性分析2014年9月至2020年4月丽水市中心医院和广西医科大学第一附属医院经病理证实且在磁共振增强扫描中呈现富动脉血供的IMCC患者的临床资料。按根治方法分为手术组(n=24)及介入组(n=13),采用t检验和Mann-whitney U检验比较两组临床、病理及影像学资料,采用Kaplan-Meier分析和对数秩检验进行组间生存率分析。结果两组患者的术前临床一般资料、实验室检查结果、病灶的术前影像表现、术后肿瘤病理分化程度等资料的对比差异均无统计学意义(均P>0.05)。介入组术后总并发症发生率低于手术组[38.5%(5/13)vs 91.7%(22/24),Z=-3.432,P=0.001]。随访0.6~109.3个月,期间手术组死亡7例、存活17例、复发12例,平均生存时间82.2个月,总生存率(OS)为70.8%,无瘤生存率(RFS)为37.2%,1、3、5年生存率分别为91.7%、79.2%、70.8%,1、3、5年复发率分别为13.6%、40.9%、50.4%;介入组死亡4例、存活9例、复发7例,平均生存时间84.7个月,OS为67.3%,RFS为44.9%,1、3、5年生存率分别为100.0%、84.6%、67.3%,1、3、5年复发率分别为15.4%、46.2%、55.1%;两组OS(χ^(2)=0.002,P=0.969)与RFS(χ^(2)=0.009,P=0.923)差异均无统计学意义。结论射频消融与外科手术对富动脉血供IMCC具有相似的治疗效果。

肝内胆管结石影响肝内胆管癌患者手术预后的回顾性分析

目的探讨肝内胆管结石(IBDS)对接受根治性手术的肝内胆管细胞癌(ICC)患者的预后影响。方法回顾性分析2010年1月至2022年9月浙江省肿瘤医院收治的204例完成根治性手术的ICC患者的临床资料,根据患者有无IBDS,分为IBDS阴性组(n=179)和IBDS阳性组(n=25),采用Kaplan-Meier法绘制生存曲线并计算累积存活率,Log-rank检验及Cox回归模型评估影响手术预后的因素。结果与IBDS阳性组比较,IBDS阴性组患者1、3、5年生存率分别为73.8%vs 40.0%、52.0%vs 26.7%、34.9%vs 0,中位生存期(OS)为20.2个月vs 10.0个月,1、3、5年的无复发生存率为54.0%vs 20.0%、30.2%vs 15.0%、25.7%vs 0,中位无复发生存期(RFS)为13.1个月vs 7.6个月,差异均有统计学意义(P<0.01)。IBDS阳性组二次分组的生存曲线分析表明,淋巴结转移严重影响IBDS阳性组ICC患者术后的OS(P=0.012),降低了IBDS阳性组ICC患者术后的RFS(P=0.004)。结论IBDS明显降低ICC患者根治性手术的远期效果,淋巴结转移则严重影响IBDS阳性ICC患者的预后;注重IBDS的治疗以及淋巴结转移的预防可能改善ICC患者手术预后。

胆管癌的当前认识与治疗研究进展

胆管癌(cholangiocarcinoma,CCA)是指发生在胆管系统上皮组织的恶性肿瘤,根据发生的部位可分为肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)和肝外胆管癌(extrahepatic cholangiocarcinoma,EHCC)两类,EHCC又可细分为肝门部胆管癌(hilar cholangiocarcinoma,HCC)与远端胆管癌(distal cholangiocarcinoma,DCC)。目前治疗CCA的方式包括手术切除、放疗、化疗及生物靶向治疗等,但是手术切除仍是其首选方法。由于CCA细胞的分化程度较高,它所依赖的微环境和遗传异质性的研究是目前的主导方向,因此对于肿瘤微环境相互作用的研究可能让我们在今后寻找到治疗CCA的最佳方案。本文将对ICC和HCC的当前认识与治疗研究进展作一概述。

机器人与开腹手术治疗肝内胆管细胞癌患者近期疗效研究

目的比较机器人与传统开腹手术行肝叶切除术治疗肝内胆管细胞癌(ICC)患者的安全性和短期疗效。方法2019年1月~2020年12月我院诊治的ICC患者27例,其中9例接受机器人手术,18例接受传统开腹肿瘤根治术,比较两组手术情况。结果两组均完成肿瘤根治术;机器人组和开腹组患者手术时间【(198±32)分对(215±74)分】、术中出血量【200(100,250)ml对275(200,300)ml】和术中输血次数(0次对2次)均无统计学差异(P>0.05);机器人组和开腹组患者肿瘤直径【4.0(2.5,5.5)cm对6.3(3.9,6.5)cm】、R0切除率(100.0%对88.0%)和淋巴结转移率(44.4%对38.9%)比较,差异无统计学意义(P>0.05);机器人组术后卧床时间和住院日分别为2(1,2.5)d和7(4,8)d,显著短于开腹组【分别为3(1.8,3.5)d和11(8,12)d,P<0.05】,机器人组住院费用为11.3(9.1,13.5)万,与开腹组的10.1(8.8,11.5)万比,无统计学差异(P>0.05);两组术后并发症发生率为11.1%和27.8%,无统计学差异(P>0.05)。结论开展机器人肿瘤根治术治疗ICC患者安全,术后恢复快。

肝内胆管细胞癌微创治疗现状及进展

肝内胆管细胞癌(ICC)是一类高侵袭性的恶性肿瘤,远期预后差,手术切除仍是其主要的治疗手段。目前,包括腹腔镜、机器人等在内的微创治疗已越来越广泛地应用于各类患者,其中相当部分是肿瘤患者。近几年国内外部分学者开始尝试应用微创手段治疗ICC患者,但关于其适应证选择及远期疗效尚存争议。该文就腹腔镜、机器人、热消融治疗ICC的研究现状及进展进行了论述。

肝内周围型胆管细胞癌的CT及MRI诊断

目的:探讨多层螺旋CT及磁共振成像(magnetic resonance im aging,MRI)对肝内周围型胆管细胞癌(intrahepatic peripheral cholangiocarcinoma,IHPCC)的诊断价值。方法 :回顾性分析2010年10月—2016年1月经病理检查证实的24例IHPCC患者的CT及MRI检查资料。结果:24例病灶中肝左叶16例,右叶8例;CT及MRI动态增强扫描24例均可见不同程度边缘强化、网格状强化、渐进性填充中度强化及延迟强化表现。肝内胆管扩张6例,病灶内见钙化2例,肝叶萎缩2例,局部肝轮廓凹陷13例。结论:IHPCC在CT及MRI上有一定的特征征象及伴随征象,动态增强扫描对IHPCC的诊断具有重要的价值。

肝内周围型胆管细胞癌的CT和MRI诊断研究

目的:探讨肝内周围型胆管细胞癌的CT和MRI诊断。方法:选取2015年12月-2017年2月本院收治的肝内周围型胆管细胞癌患者32例,所有患者均行CT检查和MRI检查,诊断后均行手术以及放疗治疗,对比分析两种方法的诊断结果。结果:MRI检查结果显示肿块清晰度明显高于CT(P<0.05),病灶强化以及在早期呈现向心化强化的例数要多于CT(P<0.05)。MRI的诊断符合率明显高于CT(P<0.05)。结论:采用MRI对肝内周围型胆管细胞癌患者进行诊断与CT相比,检查结果更加清晰准确,为早期治疗提供可靠依据,有利于改善患者的预后质量,临床上应当进一步推广应用。

肝内胆管癌手术治疗的预后影响因素分析

目的探讨肝内胆管癌患者手术治疗后炎症细胞分布与预后的相关性及影响预后的相关因素。方法纳入行手术根除治疗的肝内胆管癌患者60例,对患者的详细就诊资料、CD15、CD68炎性相关性因素及生存资料等进行相关性分析。结果分化程度、肿瘤复发、TNM分期、CA199、术中输血、手术方式、肿瘤和手术部位、术前转氨酶水平的情况是影响胆管癌预后总生存时间的独立危险因素。炎症相关因子CD15、CD68的表达与患者的总生存时间有关(P<0.05)。结论肝内胆管癌手术治疗的预后与肿瘤的分化程度、肿瘤复发、TNM分期、CA199、术中输血、手术方式、肿瘤和手术部位、术前转氨酶水平具有相关性,局部的炎症状态CD15高表达、CD68低表达是影响胆管癌患者总生存时间的独立危险因素。

外周型胆管癌的外科手术治疗(附45例报告)

目的 :探讨外周型胆管癌的外科治疗。方法 :对 45例外周型胆管癌病人进行了手术治疗 ,并对其临床病理特征、生物学指标、手术结果和生存率进行了分析。结果 :根治性手术有 34例 ,姑息性手术有 11例 ,根治性手术病人1年～ ,3年～ ,5年～生存例数分别为 2 4例 ,占 70 % ;15例 ,占 44 % ;8例 ,占 2 4%。姑息性手术病人 1年～ ,3年～ ,5年～生存例数分别为 3例 ,占 2 7% ;1例 ,占 9% ;0。根治性手术病人 1年～ ,3年～ ,5年～生存率高于姑息性手术病人的生存率。结论 :根治性肝切除术能提高外周型胆管癌的生存率。

肝内周围型胆管细胞癌的CT及MRI诊断与临床意义对照分析

目的探讨肝内周围型胆管细胞癌(Intrahepaticperipheral cholangiocarcinoma,HPCC)的CT及MRI诊断与临床意义对照分析。方法选取自2014年11月到2016年8月在我院就诊的68例疑似HPCC患者作为研究对象,所有研究对象入院后接受CT、MRI检查,并给予后期病理学诊断,其中45例为HPCC确诊患者,剩余23例为胆管下段良性肿瘤患者。比较CT、MRI联合检查和CT、MRI单独检查的灵敏度、特异度、阳性预测值、阴性预测值以及符合率。结果 CT检查的灵敏度为71.11%,特异度为73.91%,阳性预测值为84.21%,阴性预测值为56.67%,符合率为72.06%。MRI检查的灵敏度为75.56%,特异度为82.61%,阳性预测值为89.47%,阴性预测值为63.33%,符合率为77.94%。CT、MRI联合检查的灵敏度为91.11%,特异度为95.65%,阳性预测值为97.62%,阴性预测值为84.62%,符合率为92.65%。CT、MRI联合检查的灵敏度、特异度、阳性预测值、阴性预测值、符合率显著高于CT单独检查,灵敏度、符合率显著高于MRI单独检查,且以上差异具备统计学意义(P<0.05)。结论 CT、MRI联合检查对肝内周围型胆管细胞癌鉴别诊断效果较好,临床应用价值高。

肝内胆管细胞癌根治术后辅助化疗的价值

目的探讨辅助化疗对肝内胆管细胞癌根治术后患者的生存影响。方法回顾性分析127例肝内胆管细胞癌根治性切除术后的患者。28例进行术后化疗(化疗组),99例术后未进行化疗。采用SPSS软件的倾向得分匹配功能,按照分期、肿瘤大小、分化程度、切缘、淋巴结转移、年龄和性别的优先级顺序匹配,从99例未化疗患者中找出28例(未化疗组)与接受辅助化疗的患者匹配。未化疗组患者肝内胆管细胞癌根治术后无特殊处理。比较两组患者治疗效果与生存时间。通过Kaplan Meier法分析术后辅助化疗和未辅助化疗患者中位无复发生存时间和中位生存时间。结果56例患者均获得随访,随访时间为2~56个月,中位随访时间为20个月。化疗组患者中位总生存时间为43个月(范围12.0~74.0个月),1、2、3和4年总生存率分别为75.0%、35.7%、17.9%和14.3%;无进展中位生存时间为11.7个月(范围4.0~19.3个月),1、2、3和4年无进展生存率分别为50.0%、14.3%、10.7%和10.7%。未化疗组患者中位总生存时间为15.8个月(范围7.9~23.7个月),1、2、3和4年总生存率分别为53.6%、25.0%、10.7%和3.6%;无进展中位生存时间为10个月(范围2.2~17.7个月),1、2、3和4年无进展生存率分别为39.3%、14.3%、10.7%和3.6%。化疗组和未化疗组的中位总生存时间和中位无进展生存时间比较有延长的趋势,但是差异均无统计学意义(均P>0.05)。结论化疗对肝内胆管癌术后患者显示出一定的生存获益趋势,值得临床进一步研究。