Optimal liver drainage rate for survival in patients with unresectable malignant hilar biliary obstruction using 3D-image volume analyzer.

IF 3.9 3区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY Therapeutic Advances in Gastroenterology Pub Date : 2023-10-27 eCollection Date: 2023-01-01 DOI:10.1177/17562848231206980

Kosaku Morimoto, Kazuyuki Matsumoto, Taisuke Obata, Takashi Oda, Kazuya Miyamoto, Akihiro Matsumi, Hiroyuki Terasawa, Yuki Fujii, Tatsuhiro Yamazaki, Shigeru Horiguchi, Koichiro Tsutsumi, Hironari Kato, Motoyuki Otsuka

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Abstract

Background: Drainage exceeding 50% of total liver volume is a beneficial prognostic factor in patients with unresectable malignant hilar biliary obstruction (UMHBO). However, it is unclear what threshold percentage of total liver volume drained ('liver drainage rate') significantly improves survival in patients with UMHBO who received systemic chemotherapy.

Objectives: We aimed to assess the optimal liver drainage rate that improves survival in patients with UMHBO receiving chemotherapy using a three-dimensional (3D)-image volume analyzer.

Design: This study was a single-center retrospective cohort study.

Methods: Data from 90 patients with UMHBO who received chemotherapy after endoscopic biliary drainage using metal stents at Okayama University Hospital from January 2003 to December 2020 were reviewed. The liver drainage rate was calculated by dividing the drained liver volume by the total liver volume using a 3D-image volume analyzer. The primary endpoint was overall survival by liver drainage rate. The secondary endpoints were time to recurrent biliary obstruction (TRBO) and prognostic factors.

Results: The median total liver volume was 1172 (range: 673-2032) mL, and the median liver drainage rate was 83% (range: 50-100). Overall survival was 376 (95% CI: 271-450) days, and patients with >80% drainage (n = 67) had significantly longer survival than those with <80% drainage (n = 23) (450 days versus 224 days, p = 0.0033, log-rank test). TRBO was 201 (95% CI: 155-327) days and did not differ significantly by liver drainage rate. Multivariate Cox proportional hazards regression analysis revealed >80% liver drainage [hazard ratio (HR): 0.35, 95% CI: 0.20-0.62, p = 0.0003] and hilar cholangiocarcinoma (HR: 0.30, 95% CI: 0.17-0.50, p < 0.0001) as significant prognostic factors.

Conclusion: In patients with UMHBO scheduled for chemotherapy, >80% drainage is associated with improved survival. Further prospective multicenter studies are needed to verify the results of this study.

Trail registration: Okayama University Hospital, IRB number: 2108-011.

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应用三维图像体积分析仪对无法切除的恶性肝门胆管梗阻患者的最佳肝引流率和生存率。

背景：引流超过肝总体积的50%是不可切除的恶性肝门胆管梗阻（UMHBO）患者的有益预后因素。然而，尚不清楚在接受全身化疗的UMHBO患者中，肝总排出量的阈值百分比（“肝排出率”）能显著提高生存率。目的：我们旨在使用三维（3D）图像体积分析仪评估提高UMHBO化疗患者生存率的最佳肝脏引流率。设计：本研究为单中心回顾性队列研究。方法：回顾2003年1月至2020年12月在冈山大学医院接受金属支架内镜胆道引流化疗的90例UMHBO患者的数据。通过使用3D图像体积分析器将排出的肝脏体积除以总肝脏体积来计算肝脏排出率。主要终点是肝引流率的总生存率。次要终点是复发性胆道梗阻（TRBO）的时间和预后因素。结果：中位总肝容量为1172（范围：673-2032） mL，中位肝引流率为83%（范围：50-100）。总生存率为376（95%可信区间：271-450）天，引流率>80%的患者（n = 67）的生存期明显长于n = 23）（450 天与224天天，p = 0.0033，对数秩检验）。TRBO为201（95%可信区间：155-327）天，并且在肝引流率方面没有显著差异。多变量Cox比例风险回归分析显示肝引流>80%[风险比（HR）:0.35，95%CI:0.20-0.62，p = 0.0003]和肝门部胆管癌（HR:0.30，95%CI:0.17-0.50，p 结论：在计划化疗的UMHBO患者中，>80%的引流与提高生存率有关。需要进一步的前瞻性多中心研究来验证这项研究的结果。预约挂号：冈山大学医院，IRB编号：2108-011。

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来源期刊

Therapeutic Advances in Gastroenterology GASTROENTEROLOGY & HEPATOLOGY-

CiteScore

6.70

自引率

2.40%

发文量

103

审稿时长

15 weeks

期刊介绍： Therapeutic Advances in Gastroenterology is an open access journal which delivers the highest quality peer-reviewed original research articles, reviews, and scholarly comment on pioneering efforts and innovative studies in the medical treatment of gastrointestinal and hepatic disorders. The journal has a strong clinical and pharmacological focus and is aimed at an international audience of clinicians and researchers in gastroenterology and related disciplines, providing an online forum for rapid dissemination of recent research and perspectives in this area. The editors welcome original research articles across all areas of gastroenterology and hepatology. The journal publishes original research articles and review articles primarily. Original research manuscripts may include laboratory, animal or human/clinical studies – all phases. Letters to the Editor and Case Reports will also be considered.