周围胆管癌:微观阳性边缘及其临床相关性
Giacomo Waller1, Hideo Takahashi1, Yuki Bekki2
1Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA.
概括
周围胆管癌切除后的阳性胆管边缘 (R1) 并没有影响生存率. 淋巴结转移是主要的风险因素,但辅助放射治疗改善了R1患者的无病生存率.
科学领域:
- 在瘤学瘤学.
- 手术瘤学手术瘤学
- 胃肠病学 胃肠病学
背景情况:
- 周周胆道癌 (PHC) 切除后的阳性胆道边缘 (R1) 的预后意义尚未得到充分确立.
- 在这种情况下,关于辅助放射治疗 (RT) 的疗效的证据有限.
研究的目的:
- 研究R1切除对PHC患者生存结果的影响.
- 为了确定PHC切除后总生存 (OS) 和无病生存 (DFS) 的预后因素.
- 评估辅助RT在R1边缘患者中的作用.
主要方法:
- 在1997年至2018年期间,对110名患者进行了治疗意图切除PHC的回顾性审查.
- 分析总生存率 (OS) 和无病生存率 (DFS) 作为主要结局.
- 单变量和多变量分析以确定OS和DFS的风险因素.
主要成果:
- 在45.5%的患者中发现了R1边际. 总体存活率和无病存活率根据边际状态没有显著差异.
- 淋巴结转移是恶化OS和DFS的重要独立预测因素. 更大的瘤大小预测了复发.
- 辅助化疗与改善的生存状况有关. 在R1边缘的患者中,辅助RT与较长的DFS相关,但不是OS.
结论:
- 单独的R1切除与这个PHC队列的低生存率无关.
- 淋巴结转移成为最关键的预后因素.
- 辅助RT证明了在R1患者中改善DFS的潜力,这表明它对局部控制的有用性以及需要前性验证.
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