한국간담췌외과학회지 (Annals of Hepato-Biliary-Pancreatic Surgery)

  • 제14권3호
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  • Pages.165-172
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  • 2010
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  • 2508-5778(pISSN)
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  • 2508-5859(eISSN)
한국간담췌외과학회 (The Korean Association of Hepato-Biliary-Pancreatic Surgery)
권호 표지

간외 담관암의 수술적 절제 후 재발 및 생존율에 영향을 미치는 조직병리학적 예후 인자

Histopathologic Prognostic Factors for Recurrence and Survival after Surgical Resection of Middle and Distal Bile Duct Cancer

  • 박지영 (전남대학교 의과대학 외과학교실) ;
  • 김호현 (전남대학교 의과대학 외과학교실) ;
  • 박은규 (전남대학교 의과대학 외과학교실) ;
  • 성진식 (전남대학교 의과대학 외과학교실) ;
  • 허영회 (전남대학교 의과대학 외과학교실) ;
  • 고양석 (전남대학교 의과대학 외과학교실) ;
  • 김정철 (전남대학교 의과대학 외과학교실) ;
  • 조철균 (전남대학교 의과대학 외과학교실) ;
  • 김현종 (전남대학교 의과대학 외과학교실)
  • Park, Ji-Young (Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Ho-Hyun (Department of Surgery, Chonnam National University Medical School) ;
  • Park, Eun-Kyu (Department of Surgery, Chonnam National University Medical School) ;
  • Seoung, Jin-Shick (Department of Surgery, Chonnam National University Medical School) ;
  • Hur, Young-Hoe (Department of Surgery, Chonnam National University Medical School) ;
  • Koh, Yang-Seok (Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Jung-Chul (Department of Surgery, Chonnam National University Medical School) ;
  • Cho, Chol-Kyoon (Department of Surgery, Chonnam National University Medical School) ;
  • Kim, Hyun-Jong (Department of Surgery, Chonnam National University Medical School)
  • 발행 : 2010.09.30
⟨ 이전 논문 다음 논문 ⟩

초록

Purpose: Surgery remains the only curative option for patients with extrahepatic bile duct cancer (EHBD Ca). But, long-term survival is typically not good because of the advanced stage of disease at the time of diagnosis and frequent disease recurrence after surgical resection. The purpose of this study was to evaluate factors that influence survival and recurrence after surgical resection of EHBD Ca. Methods: A retrospective analysis of 113 patients who had received surgical resection for EHBD Ca between 2004 and 2009 was done. We investigated histopathological features, and survival and recurrence rates, and evaluated prognostic factors affecting survival and disease recurrence after surgical resection. Results: Overall survival rates for 1, 3 and 5 years were 73.2%, 42.8%, and 36.0% respectively. In univariate analysis, prognostic factors influencing survival were histologic differentiation, T stage, lymph node (LN) metastasis, TNM stage, perineural invasion (PNI), lymphovascular invasion (LVI) and resection margin state. Among them, LN metastasis, PNI and resection margin state were found to be independent prognostic factors for overall survival in multivariate analysis. Recurrence occurred in 44 patients (48.9%) and disease-free survival rates were 50.6% at 1 year and 38.3% at 3 year. Univariate analysis revealed that histologic differentiation, T stage, LN metastasis, TNM stage, PNI and LVI were significantly associated with recurrence. In multivariate analysis, only LN metastasis was found to be a significant independent predictor of recurrence. Conclusion: LN metastasis, PNI and positive resection margin were significant prognostic factors affecting survival. LN metastasis was found to be a significant independent predictor of recurrence in surgical resection of EHBD Ca.

키워드

참고문헌

  1. Carriaga MT, Henson DE. Liver, gallbladder, extrahepatic bile ducts, and pancreas. Cancer 1995;75(Suppl 1):171-190. https://doi.org/10.1002/1097-0142(19950101)75:1+<171::AID-CNCR2820751306>3.0.CO;2-2
  2. Shin HR, Jung KW, Won YJ, Park JG, 139 KCCR-affiliated Hospitals. 2002 annual report of the Korea Central Cancer Registry: based on registered data from 139 hospitals. Cancer Res Treat Carriaga MT, Henson DE 2004;36:103-114.
  3. Longmire WP, McArthur MS, Bastounis EA, Hiatt J. Carcinoma of the extrahepatic biliary tract. Ann Surg 1973;178: 333-345. https://doi.org/10.1097/00000658-197309000-00013
  4. Nagorney DM, Donohue JH, Farnell MB, Schleck CD, Ilstrup DM. Outcomes after curative resections of cholangiocarcinoma. Arch Surg 1993;128:871-877. https://doi.org/10.1001/archsurg.1993.01420200045008
  5. Park SW, Park YS, Chung JB, et al. Patterns and relevant factors of tumor recurrence for extrahepatic bile duct carcinoma after radical resection. Hepatogastroenterology 2004;51: 1612-1618.
  6. Jang JY, Kim SW, Park DJ, et al. Actual long-term outcome of extrahepatic bile duct cancer after surgical resection. Ann Surg 2005;241:77-84.
  7. Choi SB, Park SW, Kim KS, Choi JS, Lee WJ. The survival outcome and prognostic factors for middle and distal bile duct cancer following surgical resection. Surg Oncol 2009;99: 335-342. https://doi.org/10.1002/jso.21238
  8. Zerbi A, Balzano G, Leone BE, Angeli E, Veronesi P, Di Carlo V. Clinical presentation, diagnosis and survival of resected distal bile duct cancer. Dig Surg 1998;15:410-416. https://doi.org/10.1159/000018654
  9. Yoshida T, Matsumoto T, Sasaki A, Morii Y, Aramaki M, Kitano S. Prognostic factors after pancreatoduodenectomy with extended lymphadenectomy for distal bile duct cancer. Arch Surg 2002;137:69-73. https://doi.org/10.1001/archsurg.137.1.69
  10. Murakami Y, Uemura K, Hayashidani Y, et al. Prognostic significance of lymph node metastasis and surgical margin status for distal cholangiocarcinoma. J Surg Oncol 2007;95:207-212. https://doi.org/10.1002/jso.20668
  11. Sasaki R, Takeda Y, Funato O, et al. Significance of ductal margin status in patients undergoing surgical resection for extrahepatic cholangiocarcinoma. World J Surg 2007;31:1788- 1796. https://doi.org/10.1007/s00268-007-9102-7
  12. Sakamoto Y, Kosuge T, Shimada K, et al. Prognostic factors of surgical resection in middle and distal bile duct cancer: an analysis of 55 patients concerning the significance of ductal and radial margins. Surgery 2005;137:396-402. https://doi.org/10.1016/j.surg.2004.10.008
  13. Murakami Y, Uemura K, Hayashidani Y, Sudo T, Ohge H, Sueda T. Pancreatoduodenectomy for distal cholangiocarcinoma: prognostic impact of lymph node metastasis. World J Surg 2007;31:337-342. https://doi.org/10.1007/s00268-006-0224-0
  14. Sagawa N, Kondo S, Morikawa T, Okushiba S, Katoh H. Effectiveness of radiation therapy after surgery for hilar cholangiocarcinoma. Surg Today 2005;35:548-552. https://doi.org/10.1007/s00595-005-2989-4
  15. Alberts SR, Al-Khatib H, Mahoney MR, et al. Gemcitabine, 5-fluorouracil, and leucovorin in advanced biliary tract and gallbladder carcinoma: a North Central Cancer Treatment Group phase II trial. Cancer 2005;103:111-118. https://doi.org/10.1002/cncr.20753
  16. Hernandez J, Cowgill SM, Al-Saadi S, et al. An aggressive approach to extrahepatic cholangiocarcinomas is warranted: margin status does not impact survival after resection. Ann Surg Oncol 2008;15:807-814. https://doi.org/10.1245/s10434-007-9756-2
  17. Kim S, Kim SW, Bang YJ, Heo DS, Ha SW. Role of postoperative radiotherapy in the management of extrahepatic bile duct cancer. Int J Radiat Oncol Biol Phys 2002;54:414-419. https://doi.org/10.1016/S0360-3016(02)02952-8
  18. Hong SM, Pawlik TM, Cho H, et al. Depth of tumor invasion better predicts prognosis than the current American Joint Committee on Cancer T classification for distal bile duct carcinoma. Surgery 2009;146:250-257. https://doi.org/10.1016/j.surg.2009.02.023
  19. He P, Shi JS, Chen WK, Wang ZR, Ren H, Li H. Multivariate statistical analysis of clinicopathologic factors influencing survival of patients with bile duct carcinoma. World J Gastroenterol 2002;8:943-946. https://doi.org/10.3748/wjg.v8.i5.943
  20. Bhuiya MR, Nimura Y, Kamiya J, et al. Clinicopathologic studies on perineural invasion of bile duct carcinoma. Ann Surg 1992;215:344-349. https://doi.org/10.1097/00000658-199204000-00007
  21. Sasaki R, Takahashi M, Funato O, et al. Prognostic significance of lymph node involvement in middle and distal bile duct cancer. Surgery 2001;129:677-683. https://doi.org/10.1067/msy.2001.114555
  22. Nomura T, Tsuchiya Y, Nashimoto A, et al. Prognostic factors for radical resection of middle and distal bile duct cancer. Hepatogastroenterology 2009;56:294-298.
  23. Kayahara M, Nagakawa T, Ohta T, Kitagawa H, Tajima H, Miwa K. Role of nodal involvement and the periductal soft-tissue margin in middle and distal bile duct cancer. Ann Surg 1999;229:76-83. https://doi.org/10.1097/00000658-199901000-00010
  24. Wakai T, Shirai Y, Moroda T, Yokoyama N, Hatakeyama K. Impact of ductal resection margin status on long-term survival in patients undergoing resection for extrahepatic cholangiocarcinoma. Cancer 2005;103:1210-1216. https://doi.org/10.1002/cncr.20906
  25. Reding R, Buard JL, Lebeau G, Launois B. Surgical management of 552 carcinomas of the extrahepatic bile ducts (gallbladder and periampullary tumors excluded). Results of the French Surgical Association Survey. Ann Surg 1991;213: 236-241. https://doi.org/10.1097/00000658-199103000-00010
  26. Yeo CJ, Pitt HA, Cameron JL. Cholangiocarcinoma. Surg Clin North Am 1990;70:1429-1447. https://doi.org/10.1016/S0039-6109(16)45293-X
  27. Chen JW, Bhandari M, Astill DS, et al. Predicting patient survival after pancreaticoduodenectomy for malignancy: histopathological criteria based on perineural infiltration and lymphovascular invasion. HPB (Oxford) 2010;12:101-108. https://doi.org/10.1111/j.1477-2574.2009.00140.x
  28. Nagakawa T, Mori K, Nakano T, et al. Perineural invasion of carcinoma of the pancreas and biliary tract. Br J Surg 1993;80:619-621. https://doi.org/10.1002/bjs.1800800526
  29. Takahashi T, Ishikura H, Motohara T, Okushiba S, Dohke M, Katoh H. Perineural invasion by ductal adenocarcinoma of the pancreas. J Surg Oncol 1997;65:164-170. https://doi.org/10.1002/(SICI)1096-9098(199707)65:3<164::AID-JSO4>3.0.CO;2-4
  30. Park DJ, Kim SW, Jang JY, et al. Clinical results in the treatment of extrahepatic bile duct cancer and long-term survivors' characteristics after surgical resection. Korean J Hepatobiliary Pancreat Surg 2002;6:80-88.