多灶性肝内胆管癌根治性切除后肝脏病变数量的预后意义:IPTW倾向评分分析。

IF 3.4 2区 医学 Q2 ONCOLOGY
Xin Zhang, Xi-Tai Huang, Jin-Zhao Xie, Ai-Qing Fu, Wei Chen, Jian-Peng Cai, Li-Jian Liang, Xiao-Yu Yin
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引用次数: 0

摘要

背景:多灶性肝脏病变是肝内胆管癌(iCCA)中一个独特的亚群,这些患者的治疗仍然存在争议。本研究旨在比较不同肝脏病变数量的肝内胆管癌(iCCA)的生存率,并选择多灶性胆管癌手术获益最多的患者。方法:纳入连续354例iCCA患者的队列。根据肝脏病变的数量将患者分为:单发肿瘤(I型)、同侧肝叶2个或3个肝病变(II型)、同侧肝叶3个以上肝病变(III型)。采用稳定逆概率治疗加权(IPTW)进行准确的预后比较。并比较不同美国癌症联合委员会的远期预后。结果:在所有患者中,多灶性iCCA的总生存期(OS)和无复发生存期(RFS)明显低于单发性肿瘤(p)。结论:多灶性iCCA预后明显差,肝脏病变数量显著影响多灶性iCCA的预后。与孤立性肿瘤相比,II型肿瘤患者可以从手术中获得相当的肿瘤益处,但仍强烈推荐根治性手术作为首选治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prognostic significance of the number of hepatic lesions in multifocal intrahepatic cholangiocarcinoma after radical resection: an IPTW propensity-score analysis.

Background: Multifocal hepatic lesions represent a distinctive subgroup within intrahepatic cholangiocarcinoma(iCCA), the management of these patients remains controversial. This study aimed to compare the survival of intrahepatic cholangiocarcinoma (iCCA) with different numbers of hepatic lesions and select patients benefiting most from surgery in multifocal iCCA.

Methods: A cohort of 354 consecutive iCCA patients were included. Based on the number of hepatic lesions, patients were classified as follows: solitary tumors (type I), 2 or 3 hepatic lesions in the same-sided hepatic lobe (type II), and more than three hepatic lesions in the same-sided hepatic lobe (type III). Stabilized inverse probability treatment weighting (IPTW) was conducted for accurate prognosis comparisons. Furthermore, the long-term prognosis was compared between different American Joint Committee on Cancer.

Results: Among all patients, multifocal iCCA presented significantly worse overall survival (OS) and recurrence-free survival (RFS) than solitary tumor (p < 0.001 and p < 0.001), 11.9% (n = 42), and 14.4% (n = 51) patients were classified into type II, and type III, respectively. After IPTW, type II exhibited similar while type III exhibited worse RFS and OS to type I cohort (solitary tumors) (p < 0.001and p < 0.001). Multivariable Cox analysis also identified type III tumors as an independent risk factor for OS (HR 1.95, 95% CI:1.33-2.87, p < 0.001). Among AJCC stage II (T2N0M0) patients, multifocal iCCA presented significantly worse OS than solitary tumors (vascular invasion) (p = 0.018), and type II exhibited similar while type III exhibited worse OS than solitary tumors (p = 0.500 and p = 0.040). Compared with stage III patients, type II exhibited better while type III exhibited similar OS (p < 0.001 and p = 0.300).

Conclusions: Multifocal iCCA presented a significantly worse prognosis, the number of hepatic lesions significantly influenced the prognosis of multifocal iCCA. Patients with type II tumors may derive comparable oncological benefits from surgery compared with solitary tumors, radical surgery still be strongly recommended as the preferred treatment.

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来源期刊
BMC Cancer
BMC Cancer 医学-肿瘤学
CiteScore
6.00
自引率
2.60%
发文量
1204
审稿时长
6.8 months
期刊介绍: BMC Cancer is an open access, peer-reviewed journal that considers articles on all aspects of cancer research, including the pathophysiology, prevention, diagnosis and treatment of cancers. The journal welcomes submissions concerning molecular and cellular biology, genetics, epidemiology, and clinical trials.
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