Liver Cancer:肿瘤微环境的神经纤维密度(NFD)是肝门部胆管癌(pCCA)术后的重要预后指标

2021-05-18 yd2015 MedSci原创

肝门部胆管癌(pCCA)是胆管癌常见的一种亚型,通常预后也较差。手术切除是其治愈的手段。但是术后的并发症以及死亡率也较高。肿瘤分化、RO切除以及淋巴结状态是其预后因素。也有研究表明围手术期输血、血清白

肝门部胆管癌(pCCA)是胆管癌常见的一种亚型,通常预后也较差。手术切除是其治愈的手段。但是术后的并发症以及死亡率也较高。肿瘤分化、RO切除以及淋巴结状态是其预后因素。也有研究表明围手术期输血、血清白蛋白水平和淋巴管浸润等是pCCA的独立预后因素。pCCA组织中有着大量的结缔组织间质组成。神经纤维是肿瘤微环境的重要组成成分。而神经纤维密度(NFD)为肿瘤微环境中小的神经纤维,通常不能够被HE染色识别。其在肝门部胆管癌(pCCA)的预后价值还没有被阐明。因此,来自德国的研究团队在Liver Cancer杂志上发表了相关研究,评估NFD在手术切除后pCCA患者的预后价值。

研究纳入了2010年至2019年共101例患者。分析NFD与肿瘤特异生存期(CSS)、无瘤生存期(RFS)以及临床病理特征参数的关系。CSS定义为肿瘤切除后到肿瘤导致的死亡,排除非肿瘤导致的死亡;RFS定义为肿瘤切除后到肿瘤第一次复发。纳入的101例患者中,68例为男性(67%),33例为女性 (33%),中位年龄为68 岁。高NFD定义为≥10 神经纤维,低NFD则为<10神经纤维。

                                     研究概况

中位随访时间为53个月时,总人群中位CSS为49个月(95% CI: 29–69),中位OS为33个月(95% CI: 19–47),中位PFS为37个月(95% CI: 18–56)。高NFD患者中位CSS为90个月(95% CI: 48–132, 3-year CSS = 77%, 5-year CSS = 72%),而低NFD患者的中位CSS为33个月(95% CI: 19–47, 3-year CSS = 46%, 5-year CSS = 32%),两组CSS有明显的统计学差异(p =0.006)。高NFD患者中位RFS为83个月(95% CI: 34–132),而低NFD患者的中位RFS为24个月(95% CI: 13–35),两组RFS有明显的统计学差异(p =0.004)。

          总人群的生存或高低NFD对CSS、RFS的影响

高NFD和淋巴结阴性患者,中位CSS为90个月(95% CI: 57–123, 3-year CSS = 88%, 5-year CSS= 80%),低NFD或淋巴结阳性患者,中位CSS为51个月(95% CI: 38–64, 3-year CSS = 59%,5-year CSS =45%),而低NFD和淋巴结阳性患者,中位CSS为24个月(95% CI:14–32, 3-year CSS = 26%, 5-year CSS = 16%),三组的CSS比较有统计学差异(p=0.001)。同样,高NFD和淋巴结阴性患者,中位RFS为83个月(95% CI: 42–124),低NFD或淋巴结阳性患者,中位RFS为45个月(95% CI: 8–82),而低NFD和淋巴结阳性患者,中位RFS为10个月(95% CI: 0–21),三组的RFS比较也有统计学差异(p=0.001)。

                        NFD联合淋巴结对CSS和RFS的影响

多因素回归分析,术中输注新鲜冰冻血浆(FFP)(HR = 2.90, p = 0.004), 淋巴结状态(HR = 2.84, p = 0.001)和NFD (HR = 0.41, p = 0.024)是CSS的独立预后因素;而RFS的独立预后因素为术中输注新鲜冰冻血浆(FFP)(HR = 3.10, p= 0.002), 淋巴结状态(HR = 2.92, p = 0.001), 微血管浸润(MVI)(HR =1.98, p = 0.048) 和 NFD (HR = 0.42, p = 0.031)。

综上,神经纤维密度(NFD)是肝门部胆管癌(pCCA)重要的预后指标,其单独或与淋巴结联合可很好的预测术后pCCA患者的临床预后。

原始出处:

Jan Bednarsch, Jakob Kather, Xiuxiang Tan, et al. Nerve Fibers in the Tumor Microenvironment as a Novel Biomarker for Oncological Outcome in Patients Undergoing Surgery for Perihilar Cholangiocarcinoma. Liver Cancer. 2021. DOI: 10.1159/000515303

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    2021-05-20 njwbhuang

    学习了

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1374195, encodeId=f1a813e41951b, content=<a href='/topic/show?id=8de610018644' target=_blank style='color:#2F92EE;'>#预后指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100186, encryptionId=8de610018644, topicName=预后指标)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca3c375, createdName=jwf_2001, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1489785, encodeId=4f771489e85f1, content=<a href='/topic/show?id=5293e447259' target=_blank style='color:#2F92EE;'>#神经纤维#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74472, encryptionId=5293e447259, topicName=神经纤维)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53f28597470, createdName=stfoxst, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510544, encodeId=f49b151054424, content=<a href='/topic/show?id=589b815113c' target=_blank style='color:#2F92EE;'>#肝门部胆管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81511, encryptionId=589b815113c, topicName=肝门部胆管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5cae10200112, createdName=小刀医生, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628482, encodeId=6a5e162848200, content=<a href='/topic/show?id=9a4e83503e4' target=_blank style='color:#2F92EE;'>#胆管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83503, encryptionId=9a4e83503e4, topicName=胆管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c21721182790, createdName=cmj15wellington, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=967197, encodeId=15d396e19735, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43a21971117, createdName=njwbhuang, createdTime=Thu May 20 12:04:36 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966989, encodeId=e8d49669893d, content=这确实非常好的话题, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0acb2570971, createdName=12582d2fm84暂无昵称, createdTime=Wed May 19 18:57:13 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966890, encodeId=bf3796689074, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Wed May 19 14:24:54 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966843, encodeId=83a9966843af, content=棒!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb155504115, createdName=ms1000000055856980, createdTime=Wed May 19 11:43:17 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966686, encodeId=c722966686e1, content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=ms2000001051330459, createdTime=Tue May 18 22:40:11 CST 2021, time=2021-05-18, status=1, ipAttribution=)]
    2021-05-19 12582d2fm84暂无昵称

    这确实非常好的话题

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1374195, encodeId=f1a813e41951b, content=<a href='/topic/show?id=8de610018644' target=_blank style='color:#2F92EE;'>#预后指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100186, encryptionId=8de610018644, topicName=预后指标)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca3c375, createdName=jwf_2001, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1489785, encodeId=4f771489e85f1, content=<a href='/topic/show?id=5293e447259' target=_blank style='color:#2F92EE;'>#神经纤维#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74472, encryptionId=5293e447259, topicName=神经纤维)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53f28597470, createdName=stfoxst, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510544, encodeId=f49b151054424, content=<a href='/topic/show?id=589b815113c' target=_blank style='color:#2F92EE;'>#肝门部胆管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81511, encryptionId=589b815113c, topicName=肝门部胆管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5cae10200112, createdName=小刀医生, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628482, encodeId=6a5e162848200, content=<a href='/topic/show?id=9a4e83503e4' target=_blank style='color:#2F92EE;'>#胆管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83503, encryptionId=9a4e83503e4, topicName=胆管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c21721182790, createdName=cmj15wellington, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=967197, encodeId=15d396e19735, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43a21971117, createdName=njwbhuang, createdTime=Thu May 20 12:04:36 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966989, encodeId=e8d49669893d, content=这确实非常好的话题, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0acb2570971, createdName=12582d2fm84暂无昵称, createdTime=Wed May 19 18:57:13 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966890, encodeId=bf3796689074, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Wed May 19 14:24:54 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966843, encodeId=83a9966843af, content=棒!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb155504115, createdName=ms1000000055856980, createdTime=Wed May 19 11:43:17 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966686, encodeId=c722966686e1, content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=ms2000001051330459, createdTime=Tue May 18 22:40:11 CST 2021, time=2021-05-18, status=1, ipAttribution=)]
    2021-05-19 JZ Yang

    0

  8. [GetPortalCommentsPageByObjectIdResponse(id=1374195, encodeId=f1a813e41951b, content=<a href='/topic/show?id=8de610018644' target=_blank style='color:#2F92EE;'>#预后指标#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100186, encryptionId=8de610018644, topicName=预后指标)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=ca3c375, createdName=jwf_2001, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1489785, encodeId=4f771489e85f1, content=<a href='/topic/show?id=5293e447259' target=_blank style='color:#2F92EE;'>#神经纤维#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=74472, encryptionId=5293e447259, topicName=神经纤维)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=53f28597470, createdName=stfoxst, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510544, encodeId=f49b151054424, content=<a href='/topic/show?id=589b815113c' target=_blank style='color:#2F92EE;'>#肝门部胆管癌#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=44, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=81511, encryptionId=589b815113c, topicName=肝门部胆管癌)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5cae10200112, createdName=小刀医生, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1628482, encodeId=6a5e162848200, content=<a href='/topic/show?id=9a4e83503e4' target=_blank style='color:#2F92EE;'>#胆管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=83503, encryptionId=9a4e83503e4, topicName=胆管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=c21721182790, createdName=cmj15wellington, createdTime=Thu May 20 13:12:33 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=967197, encodeId=15d396e19735, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=76, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=43a21971117, createdName=njwbhuang, createdTime=Thu May 20 12:04:36 CST 2021, time=2021-05-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966989, encodeId=e8d49669893d, content=这确实非常好的话题, beContent=null, objectType=article, channel=null, level=null, likeNumber=73, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=0acb2570971, createdName=12582d2fm84暂无昵称, createdTime=Wed May 19 18:57:13 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966890, encodeId=bf3796689074, content=赞, beContent=null, objectType=article, channel=null, level=null, likeNumber=70, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTJibu7hwJqpmHiaJgLLmJmcwp0WDTxWI3vqPBO1Mloq21VBOPqziapyibYatvd2QWHWicolL1vbVZHgpRQ/132, createdBy=d16a2107341, createdName=JZ Yang, createdTime=Wed May 19 14:24:54 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966843, encodeId=83a9966843af, content=棒!, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=cb155504115, createdName=ms1000000055856980, createdTime=Wed May 19 11:43:17 CST 2021, time=2021-05-19, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=966686, encodeId=c722966686e1, content=学习了,涨知识了!, beContent=null, objectType=article, channel=null, level=null, likeNumber=72, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/ajNVdqHZLLDM9swhbgTo7nzqRKzMmzckmEoeTyLQVDCgjqsicjyhxPs0vPoYU6GsSYbCjSkNHicJkz3NL0a0EbUMVdNjkctXI6FocpGKaVr9E/0, createdBy=29392048316, createdName=ms2000001051330459, createdTime=Tue May 18 22:40:11 CST 2021, time=2021-05-18, status=1, ipAttribution=)]
    2021-05-19 ms1000000055856980

    棒!

    0

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    2021-05-18 ms2000001051330459

    学习了,涨知识了!

    0

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对肝门部胆管癌(HCA)行肝切除术 (LR)依旧存在很多挑战,因为血管和单管的侵犯是无法预料的。手术的目标之一是达到切缘无肿瘤浸润,而常规门静脉切除术(PVR) 对患者的利弊一直饱受争议。研究者纳入了60例行了LR的HCA病例。其中有21(35.0%)名病人进行了LR+PVR,余下39(65.0%)名病人只行了LR。研究者通过单因素和多因素分析对数据进行处理。研究结果显示,切除术主要针对的是Bis

MDT丨多学科讨论综合治疗复杂肝门部胆管癌一例

患者58岁女性,入院2周前行体格检查发现肝功能异常、腹部超声提示肝内胆管扩张,就诊于当地医院,行MRCP发现肝门区占位、考虑胆管癌可能;患者否认腹痛、腹胀、腹泻,否认发热、乏力、纳差,否认尿色加深等表现。1年前发现乙型病毒性肝炎,未规范治疗,其他病史无特殊。入院后专科查体无皮肤、巩膜黄染,腹部查体及浅表淋巴结检查阴性。