Introduction: Perihilar cholangiocarcinoma is a rare malignancy of the biliary tract, for which surgery remains the treatment of choice. However, even after radical resection, the prognosis is poor. In addition to tumor size, depth of invasion and nodal/metastatic status, the TNM classification includes additional parameters such as perineural (Pn), lymphangio (L) and vascular (V) invasion. The prognostic impact of these factors is not yet fully understood. The aim of this study was to investigate the influence of these parameters on overall survival after resection of perihilar cholangiocarcinoma. Material and Methods: Data from all patients who underwent surgical exploration for perihilar cholangiocarcinoma between January 2013 and December 2023 were included into an institutional database. The impact of perineural, lymphangio and vascular invasion on overall survival was analyzed. Results: Over the 11-year period, a total of 214 patients underwent surgical exploration for perihilar cholangiocarcinoma. Curative intended resection was possible in 168 patients (78.5%). Perineural invasion, lymphangio invasion and vascular invasion were present in 79.2%, in 17.3% and in 14.3% of patients, respectively. Cross tabulation revealed a significant association between the presence of L1 and V1 (p= 0.006). There was also a significant association of Pn1, L1, and V1 with R-status (p= 0.010;p= 0.006 andp≤ 0.001). While V1 was associated with significantly worse overall survival across the entire cohort, Pn1 alone showed only a tendency towards worse overall survival without reaching statistical significance. In Bismuth type IV, both L1 and V1, but not Pn1, were significantly associated with worse overall survival (p= 0.001;p= 0.017 andp= 0.065). Conclusions: Perineural invasion is very common in perihilar cholangiocarcinoma. Although Pn1 was associated with a tendency toward worse survival, it did not reach statistical significance. In contrast, vascular invasion significantly worsened overall survival in the entire cohort, and lymphangio invasion was linked to worse overall survival in Bismuth type IV tumors. The combination of perineural invasion with positivity of more than one additional factor (either L or V) was also associated with worse overall survival. In patients with Bismuth type IV, these pathological markers appeared to have even greater prognostic relevance.
引言：肝门部胆管癌是一种罕见的胆道恶性肿瘤，手术仍是其主要治疗手段。然而，即使经过根治性切除，患者预后依然较差。除肿瘤大小、浸润深度及淋巴结/转移状态外，TNM分期系统还包含神经侵犯（Pn）、淋巴管侵犯（L）和血管侵犯（V）等参数。这些因素对预后的影响尚未完全明确。本研究旨在探讨这些参数对肝门部胆管癌切除术后总生存期的影响。 材料与方法：收集2013年1月至2023年12月期间所有接受手术探查的肝门部胆管癌患者数据，建立机构数据库。分析神经侵犯、淋巴管侵犯和血管侵犯对总生存期的影响。 结果：在11年期间，共有214例患者因肝门部胆管癌接受手术探查。其中168例（78.5%）实现了根治性切除。神经侵犯、淋巴管侵犯和血管侵犯的发生率分别为79.2%、17.3%和14.3%。交叉分析显示L1与V1存在显著相关性（p=0.006）。Pn1、L1和V1与切缘状态（R-status）亦存在显著关联（p值分别为0.010、0.006和≤0.001）。虽然V1在整个队列中与显著较差的总生存期相关，但Pn1仅呈现生存期缩短趋势而未达到统计学显著性。在Bismuth IV型肿瘤中，L1和V1（而非Pn1）与较差的总生存期显著相关（p值分别为0.001、0.017和0.065）。 结论：神经侵犯在肝门部胆管癌中极为常见。尽管Pn1显示出生存期缩短趋势，但未达到统计学显著性。相比之下，血管侵犯在整个队列中显著恶化总生存期，而淋巴管侵犯与Bismuth IV型肿瘤的较差生存期相关。神经侵犯合并其他任一因素（L或V）阳性也与较差的总体生存期相关。在Bismuth IV型患者中，这些病理标志物似乎具有更强的预后预测价值。
肿瘤(癌症)患者之家