Waike lilun yu shijian (Jun 2022)

Relationship between surgical margin and prognosis of patients with intrahepatic cholangiocarcinoma

  • YIN Yanjiang, LUO Zhiwen, CHEN Xiao, ZHANG Yefan, HUANG Zhen, ZHAO Hong, ZHAO Jianjun, LI Zhiyu, ZHOU Jianguo, CAI Jianqiang, BI Xinyu

DOI
https://doi.org/10.16139/j.1007-9610.2022.03.008
Journal volume & issue
Vol. 27, no. 03
pp. 221 – 228

Abstract

Read online

Objective To analyze the effect of surgical margin on the prognosis of patients with intrahepatic cholangiocarcinoma (ICC), and to explore the distance of margin of ICC hepatectomy to be recommended. Methods The clinical and pathological data of patients with ICC were collected from January 2011 to January 2017 in the Cancer Hospital in Beijing. Single-factor and multi-factor Cox analysis were used to explore risk factors that affected the prognosis of ICC. Kaplan-Meier method was used for recurrent free survival (RFS) and overall survival (OS) curves. Restricted cubic splines (RCS) were used to study the relationship between R0 margin distance and OS or RFS, and the recommended distance of surgical margin. Results There were 71 patients with median RFS 8 months and OS 17 months after follow-up from 2 to 107 months in this study. One, 3 and 5 year RFS were 35%, 20% and 10%, and OS 68%, 38%, and 23%, respectively. It was shown by Cox regression analysis that the American Joint Committee on Cancer (AJCC) staging, surgical margin, alpha-fetoprotein, carbohydrate antigen 19-9 were independent risk factors of the prognosis of ICC patients. R0 resection was in 59 (83%) cases and R1 resection in 12 (17%) cases. R0 resection was found to be more likely in the patients when tumor was single, in stage Ⅰ or stage Ⅱ of AJCC or of Liver Cancer Study Group of Japan (LCSGJ) after comparison the preoperative clinicopathological factors between R0 resection and R1 resection. Original data was pathological margin and for the shrinkage during preparation of pathological specimens, the pathological margin converted to surgical margin. Using restricted cubic spline and Kaplan-Meier method it was shown that wider margin group (>0.5 cm-<2.8 cm) had longer RFS than more narrow margin group (>0.1 cm-≤0.5 cm). Conclusions R1 resection would be an independent risk factor for the prognosis of ICC patients. When the tumor is single, AJCC staging or LCSGJ staging in stage Ⅰ or stage Ⅱ, it could be more likely to have R0 resection and surgical margin at least 0.5 cm or more could improve the prognosis.

Keywords