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KMID : 0870419990030010027
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Korean Journal of Hepato-Biliary-Pancreatic Surgery
1999 Volume.3 No. 1 p.27 ~ p.36
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Aggressive Surgical Treatment for Intrahepatic Cholangiocarcinoma and Prognostic factors
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Kim Hong-Jin
Yun Sung-Soo
Ko Juong-Uuk
Choi Joon-Hyuk
Chang Jae-Chun
Kwun Koing-Bo
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Abstract
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Background/Aims: To review the cases of surgically-treated intrahepatic cholangiocarcinoma, and to evaluate the clinical and pathologic features of intrahepatic cholangiocarcinoma that may affect longterm survival among Korean patients.
Materials and Methods: From 1990 to 1997, 28 patients with intrahepatic cholangiocarcinoma underwent laparotomy. Among them, resection was performed in 25 patients and wedge resection in only 3 patients. The liver resections included: 5 right lobectomies, 1 right trisegmentectomy, 7 left lobectomies, 3 extended left lobectomies, 2 hepatopancreatoduodenectomies and 7 segmentectomies. Curative resection was performed on 15 patients. The histological sections of all resected specimens were immunohistochemically stained with p53 and Ki-67 monoclonal antibodies to assess biological behavior of the tumor cells. The cumulative survival rate and clinicopathological factors, including biological markers (p53, Ki-67), that may influence prognosis were analyzed stastistically.
Results: The patients undergoing curative resection survived significantly longer than the patients undergoing noncurative resection. The median survival time for patients with curative resection was 24 months (mean, 34+/-8 months) with 1-, 2-, and 3-year survival rates of 66.6%, 44.4%, and 35.6%, respectively. The median survival time for patients with noncurative resection was 3 months (mean, 8+/-3 months) with 1- and 2-year survival rates of 26.7% and 13.4%, respectively. Univariate analysis showed that positive regional lymph node significantly correlated with poor prognosis (p=0.004); and that curative resection significantly correlated with better prognosis (p=0.001). Age, sex, tumor size, the degree of cell differentiation, gross type of tumor, and p53 and Ki-67 labeling index had no significant correlation with prognosis.
Conclusion: Our results support the idea that an aggressive liver resection along with regional lymph node dissection is recommended for long-term survival. The validity of the molecular biologic tumor markers (p53, Ki -67) as a prognostic factor is not yet clearly defined.
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KEYWORD
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Cholangiocarcinoma, Hepatectomy, p53, Ki-67
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