Significant Improvement in Outcomes of Patients with Intrahepatic Cholangiocarcinoma after Surgery

被引:27
|
作者
Yoh, Tomoaki [1 ]
Hatano, Etsuro [1 ]
Nishio, Takahiro [1 ]
Seo, Satoru [1 ]
Taura, Kojiro [1 ]
Yasuchika, Kentaro [1 ]
Okajima, Hideaki [1 ]
Kaido, Toshimi [1 ]
Uemoto, Shinji [1 ]
机构
[1] Kyoto Univ, Grad Sch Med, Dept Surg, Sakyo Ku, 54 Kawahara Cho, Kyoto 6068507, Japan
关键词
BILIARY-TRACT CANCER; RESECTION; CHEMOTHERAPY; GEMCITABINE; RECURRENCE; SURVIVAL; METAANALYSIS; MANAGEMENT; CISPLATIN; TRIALS;
D O I
10.1007/s00268-016-3583-1
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background The prognosis of intrahepatic cholangiocarcinoma (ICC) remains poor despite improvements in treatment and post-operative clinical management. We review our experiences and evaluate our current surgical approaches by comparing patients from two consecutive treatment periods. Methods One hundred forty-four patients who underwent hepatectomy for ICC between 1993 and 2014 were divided into groups that received treatment before (n = 65, first period) and after 2006 (n = 79, second period), when new treatment options such as adjuvant chemotherapy and multimodal therapy for recurrence were introduced. Clinicopathological characteristics and survival outcomes were compared between the groups. Results First-period patients exhibited more advanced tumor characteristics, including larger tumors, higher serum carbohydrate antigen 19-9 levels, and vascular invasion. Median overall survival (OS) durations of the first-and second-period groups were 21.4 and 57.7 months, respectively (p < 0.001); corresponding median disease-free survival (DFS) durations were 12.2 and 16.6 months, respectively (p = 0.027). Multivariate analysis found an independent association of the treatment time period with OS and DFS. Notably, second-period patients with N1 disease achieved a longer OS and DFS (median OS time: 12.4 and 26.0 months, p = 0.0018, and median DFS: 4.7 and 10.7 months p = 0.019, respectively). Among recurrent patients (first, n = 50 and second, n = 44), second-period patients had a significantly longer survival after recurrence (8.0 vs. 22.3 months, p < 0.001). Conclusion ICC patients, particularly those with N1 disease, achieved significant survival improvements that were partly attributable to patient selection, adjuvant chemotherapy, and multimodal treatment after recurrence.
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页码:2229 / 2236
页数:8
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