Supplementary Material for: Liver fibrosis is associated with poorer overall survival and higher recurrence rate in patients with cholangiocarcinoma

Introduction
Cholangiocarcinoma is the second most common primary liver tumour worldwide with an increasing incidence in recent decades. While the effects of fibrosis on hepatocellular carcinoma have been widely demonstrated, the impact on cholangiocarcinoma remains unclear. The aim of this study is to evaluate the impact of liver fibrosis on overall survival (OS) and disease-free survival (DFS) in patients who have undergone liver resection for cholangiocarcinoma.

Method
80 patients with cholangiocarcinoma who underwent curatively intended liver surgery between January 2007 and December 2020 were included in this retrospective single-center study. Clinical and histopathological features were analyzed. The primary endpoint was cause-specific survival. Secondary endpoints were DFS and identification of prognostic factors.

Results
The present study shows that the median OS is significantly reduced in patients with fibrosis (p<0.001). The median OS in patients with fibrosis was three times shorter than in the group without fibrosis. In addition, a significantly shorter DFS was observed in patients with fibrosis (p<0.002). Multivariate analysis showed that fibrosis is the strongest independent factor with a negative impact on OS and DFS.

Conclusion
Liver fibrosis has a significant impact on OS and DFS in patients with cholangiocarcinoma. Patients with known liver fibrosis require thorough perioperative care and postoperative follow-up.

引言
胆管癌（Cholangiocarcinoma）是全球范围内第二大常见原发性肝脏肿瘤，近数十年来其发病率呈持续上升趋势。尽管肝纤维化（liver fibrosis）对肝细胞癌（hepatocellular carcinoma）的影响已得到广泛证实，但其对胆管癌的作用机制仍不明确。本研究旨在评估肝纤维化对接受肝切除术（liver resection）的胆管癌患者总生存期（overall survival, OS）与无病生存期（disease-free survival, DFS）的影响。

方法
本项回顾性单中心研究纳入了2007年1月至2020年12月期间接受根治性意向肝手术的80例胆管癌患者。研究对患者的临床及组织病理学特征进行了分析，主要终点为病因特异性生存期，次要终点为无病生存期及预后因素的筛选。

结果
本研究结果显示，合并肝纤维化的患者中位总生存期显著缩短（p<0.001），其中位总生存期较无肝纤维化组缩短至其三分之一。此外，合并肝纤维化的患者无病生存期同样显著缩短（p<0.002）。多变量分析表明，肝纤维化是对总生存期与无病生存期产生负面影响的最强独立危险因素。

结论
肝纤维化对胆管癌患者的总生存期与无病生存期具有显著影响。合并已知肝纤维化的患者需要接受全面的围手术期护理与术后随访。