A N Polyakov, Yu I Patyutko, D A Granov, I S Bazin, I O Rutkin, A V Korshak, A S Turlak, D V Podluzhny
{"title":"[Prognostic factors and preoperative therapy in resectable intrahepatic cholangiocarcinoma].","authors":"A N Polyakov, Yu I Patyutko, D A Granov, I S Bazin, I O Rutkin, A V Korshak, A S Turlak, D V Podluzhny","doi":"10.17116/hirurgia20250115","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To identify prognostic factors and role of preoperative therapy for resectable intrahepatic cholangiocarcinoma (IHCC).</p><p><strong>Material and methods: </strong>We analyzed the results of surgical and combined treatment of IHCC between 1999 and 2023. Immediate and long-term outcomes were evaluated depending on negative prognostic factors and additional therapy.</p><p><strong>Results: </strong>The study included 195 patients. Postoperative complications grade ≥III were observed in 35 (17.9%) case. Mortality rate was 3.1% (<i>n</i>=6). Thirty-eight patients (19.5%) underwent treatment before surgery, 109 (55.9%) ones - after surgery. The median overall survival was 31 months, 5-year overall survival - 32.0%. The following factors worsened overall survival: node size ≥8 cm (HR 1.45; 95% CI 0.97-2.17), invasion (HR 1.63; 95% CI 1.07-2.47), multiple lesion (HR 1.51; 95% CI 1.00-2.28). R1 resection worsened disease-free survival (HR 1.88; 95% CI 1.14-3.10). Lymph node metastases decreased overall (HR 1.96; 95% CI 1.27- 3.04) and disease-free survival (HR 2.37; 95% CI 1.63-3.44). Two and more negative factors worsened overall (<i>p</i>=0.0013) and disease-free survival (<i>p</i>=0.0005). Absence of adjuvant therapy worsened overall (HR 2.12; 95% CI 1.41-3.20) and disease-free survival (HR 1.42; 95% CI 0.99-2.04). There was a trend towards higher overall (<i>p</i>=0.088) and progression-free survival (<i>p</i>=0.029) in case of preoperative therapy (<i>n</i>=195). In unfavorable prognosis group, preoperative therapy (<i>n</i>=33) was superior to standard treatment (resection+capecitabine after surgery, <i>n</i>=26). There was a trend towards higher overall survival (<i>p</i>=0.066) and significantly better progression-free survival (17 vs 13 months, <i>p</i>=0.018).</p><p><strong>Conclusion: </strong>Negative prognostic factors for resectable IHCC are lesion size ≥8 cm, intrahepatic and regional metastases, invasion into neighboring structures, R1 resection. Combination of negative factors worsened prognosis. Adjuvant therapy improved postoperative outcomes. Preoperative therapy may be advisable in case of negative factors and high risk of R1 resection.</p>","PeriodicalId":35986,"journal":{"name":"Khirurgiya","volume":" 1","pages":"5-13"},"PeriodicalIF":0.0000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Khirurgiya","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17116/hirurgia20250115","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: To identify prognostic factors and role of preoperative therapy for resectable intrahepatic cholangiocarcinoma (IHCC).
Material and methods: We analyzed the results of surgical and combined treatment of IHCC between 1999 and 2023. Immediate and long-term outcomes were evaluated depending on negative prognostic factors and additional therapy.
Results: The study included 195 patients. Postoperative complications grade ≥III were observed in 35 (17.9%) case. Mortality rate was 3.1% (n=6). Thirty-eight patients (19.5%) underwent treatment before surgery, 109 (55.9%) ones - after surgery. The median overall survival was 31 months, 5-year overall survival - 32.0%. The following factors worsened overall survival: node size ≥8 cm (HR 1.45; 95% CI 0.97-2.17), invasion (HR 1.63; 95% CI 1.07-2.47), multiple lesion (HR 1.51; 95% CI 1.00-2.28). R1 resection worsened disease-free survival (HR 1.88; 95% CI 1.14-3.10). Lymph node metastases decreased overall (HR 1.96; 95% CI 1.27- 3.04) and disease-free survival (HR 2.37; 95% CI 1.63-3.44). Two and more negative factors worsened overall (p=0.0013) and disease-free survival (p=0.0005). Absence of adjuvant therapy worsened overall (HR 2.12; 95% CI 1.41-3.20) and disease-free survival (HR 1.42; 95% CI 0.99-2.04). There was a trend towards higher overall (p=0.088) and progression-free survival (p=0.029) in case of preoperative therapy (n=195). In unfavorable prognosis group, preoperative therapy (n=33) was superior to standard treatment (resection+capecitabine after surgery, n=26). There was a trend towards higher overall survival (p=0.066) and significantly better progression-free survival (17 vs 13 months, p=0.018).
Conclusion: Negative prognostic factors for resectable IHCC are lesion size ≥8 cm, intrahepatic and regional metastases, invasion into neighboring structures, R1 resection. Combination of negative factors worsened prognosis. Adjuvant therapy improved postoperative outcomes. Preoperative therapy may be advisable in case of negative factors and high risk of R1 resection.
目的：探讨可切除肝内胆管癌（IHCC）的预后因素及术前治疗的作用。材料和方法：我们分析了1999年至2023年间IHCC的手术和联合治疗的结果。根据负面预后因素和额外治疗评估近期和长期结果。结果：纳入195例患者。术后并发症≥III级35例（17.9%）。死亡率为3.1% （n=6）。术前治疗38例（19.5%），术后治疗109例（55.9%）。中位总生存期为31个月，5年总生存期- 32.0%。以下因素使总生存期恶化：淋巴结大小≥8 cm (HR 1.45；95% CI 0.97-2.17)，侵袭(HR 1.63；95% CI 1.07-2.47)，多发病变(HR 1.51；95% ci 1.00-2.28)。R1切除使无病生存期恶化(HR 1.88；95% ci 1.14-3.10)。淋巴结转移总体减少(HR 1.96；95% CI 1.27- 3.04)和无病生存期(HR 2.37；95% ci 1.63-3.44)。两个及以上的负面因素总体恶化（p=0.0013）和无病生存（p=0.0005）。缺乏辅助治疗总体恶化(HR 2.12；95% CI 1.41-3.20)和无病生存期(HR 1.42；95% ci 0.99-2.04)。在术前治疗（n=195）的情况下，总生存率（p=0.088）和无进展生存率（p=0.029）有提高的趋势。预后不良组术前治疗（n=33）优于标准治疗（术后切除+卡培他滨，n=26）。总生存期（p=0.066）和无进展生存期（17个月vs 13个月，p=0.018）均有提高的趋势。结论：可切除的IHCC预后不良因素为病灶大小≥8cm、肝内及局部转移、浸润邻近结构、R1切除。负面因素的组合使预后恶化。辅助治疗改善了术后预后。如果有负面因素和R1切除的高风险，建议术前治疗。
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