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Abstract：
BACKGROUND: The treatment of perihilar Cholangiocarcinoma (pCCA) poses specific challenges not only due to its high perioperative complication rates but also due its dismal long-term prognosis with only a few long-term survivors (LTS) among the patients. Therefore, in this analysis characteristics and predictors of LTS in pCCA patients are investigated.
METHODS: In this single center analysis, patients undergoing curative-intent liver resection for pCCA between 2010 and 2022 were categorized into long-term and short-term survivors (STS) excluding perioperative mortality. Binary logistic regression was used to determine key differences between the groups and to develop a prognostic composite variable. This composite variable was subsequently tested in the whole cohort of surgically treated pCCA patients using Cox Regression analysis for cancer-specific survival (CSS).
RESULTS: Within a cohort of 209 individuals, 27 patients were identified as LTS (median CSS = 125 months) and 55 patients as STS (median CSS = 16 months). Multivariable analysis identified preoperative portal vein infiltration (OR = 5.85, p = 0.018) and intraoperative packed red blood cell (PRBC) transfusions (OR = 10.29, p = 0.002) as key differences between the groups. A prognostic composite variable based on these two features was created and transferred into a Cox regression model of the whole cohort. Here, the composite variable (HR = 0.35, p<0.001), lymph node metastases (HR = 2.15, p = 0.001) and postoperative complications (HR = 3.06, p<0.001) were identified as independent predictors of CSS.
CONCLUSIONS: Long-term survival after surgery for pCCA is possible and is strongly negatively associated with preoperative portal vein infiltration and intraoperative PRBC transfusion. As these variables are part of preoperative staging or can be modulated by intraoperative technique, the proposed prognostic composite variable can easily be transferred into clinical management to predict the oncological outcome of patients undergoing surgery for pCCA.
METHODS: In this single center analysis, patients undergoing curative-intent liver resection for pCCA between 2010 and 2022 were categorized into long-term and short-term survivors (STS) excluding perioperative mortality. Binary logistic regression was used to determine key differences between the groups and to develop a prognostic composite variable. This composite variable was subsequently tested in the whole cohort of surgically treated pCCA patients using Cox Regression analysis for cancer-specific survival (CSS).
RESULTS: Within a cohort of 209 individuals, 27 patients were identified as LTS (median CSS = 125 months) and 55 patients as STS (median CSS = 16 months). Multivariable analysis identified preoperative portal vein infiltration (OR = 5.85, p = 0.018) and intraoperative packed red blood cell (PRBC) transfusions (OR = 10.29, p = 0.002) as key differences between the groups. A prognostic composite variable based on these two features was created and transferred into a Cox regression model of the whole cohort. Here, the composite variable (HR = 0.35, p<0.001), lymph node metastases (HR = 2.15, p = 0.001) and postoperative complications (HR = 3.06, p<0.001) were identified as independent predictors of CSS.
CONCLUSIONS: Long-term survival after surgery for pCCA is possible and is strongly negatively associated with preoperative portal vein infiltration and intraoperative PRBC transfusion. As these variables are part of preoperative staging or can be modulated by intraoperative technique, the proposed prognostic composite variable can easily be transferred into clinical management to predict the oncological outcome of patients undergoing surgery for pCCA.
摘要：
背景：肝门周围胆管癌（pCCA）的治疗不仅由于其高的围手术期并发症发生率，而且由于其长期预后不佳，患者中只有少数长期存活者（LTS），因此面临着特殊的挑战。因此,本分析研究了pCCA患者LTS的特征和预测因素.
方法：在这个单中心分析中，2010~2022年接受pCCA根治性肝切除术的患者被分为长期和短期存活者(STS),不包括围手术期死亡率.二元逻辑回归用于确定组间的关键差异并开发预后综合变量。随后使用Cox回归分析癌症特异性存活(CSS)在手术治疗的pCCA患者的整个队列中测试该复合变量。
结果：在209个人的队列中，27例患者被确定为LTS（中位CSS=125个月），55例患者被确定为STS（中位CSS=16个月）。多变量分析确定术前门静脉浸润（OR=5.85，p=0.018）和术中红细胞（PRBC）输注（OR=10.29，p=0.002）是两组之间的关键差异。创建了基于这两个特征的预后复合变量，并将其转移到整个队列的Cox回归模型中。这里,复合变量(HR=0.35，p<0.001)，淋巴结转移（HR=2.15，p=0.001）和术后并发症（HR=3.06，p<0.001）被确定为CSS的独立预测因子。
结论：pCCA手术后的长期生存是可能的，并且与术前门静脉浸润和术中PRBC输注密切相关。由于这些变量是术前分期的一部分，或者可以通过术中技术进行调节，提出的预后复合变量可以很容易地转移到临床管理中,以预测接受pCCA手术的患者的肿瘤结局.
方法：在这个单中心分析中，2010~2022年接受pCCA根治性肝切除术的患者被分为长期和短期存活者(STS),不包括围手术期死亡率.二元逻辑回归用于确定组间的关键差异并开发预后综合变量。随后使用Cox回归分析癌症特异性存活(CSS)在手术治疗的pCCA患者的整个队列中测试该复合变量。
结果：在209个人的队列中，27例患者被确定为LTS（中位CSS=125个月），55例患者被确定为STS（中位CSS=16个月）。多变量分析确定术前门静脉浸润（OR=5.85，p=0.018）和术中红细胞（PRBC）输注（OR=10.29，p=0.002）是两组之间的关键差异。创建了基于这两个特征的预后复合变量，并将其转移到整个队列的Cox回归模型中。这里,复合变量(HR=0.35，p<0.001)，淋巴结转移（HR=2.15，p=0.001）和术后并发症（HR=3.06，p<0.001）被确定为CSS的独立预测因子。
结论：pCCA手术后的长期生存是可能的，并且与术前门静脉浸润和术中PRBC输注密切相关。由于这些变量是术前分期的一部分，或者可以通过术中技术进行调节，提出的预后复合变量可以很容易地转移到临床管理中,以预测接受pCCA手术的患者的肿瘤结局.
