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)是全球第二常见的原发性肝脏肿瘤，近数十年来发病率呈上升趋势。尽管肝纤维化对肝细胞癌(hepatocellular carcinoma)的影响已得到广泛证实，但其对胆管癌的临床影响仍不明确。本研究旨在评估肝纤维化对接受肝切除术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。本研究的主要终点为病因特异性生存期，次要终点为无病生存期以及预后因素的筛选与识别。
结果 本研究显示，合并肝纤维化的患者中位总生存期显著缩短（p<0.001），其值仅为无纤维化组患者的三分之一。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）。多因素分析表明，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预后因素。
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接受更为全面的围手术期护理与术后随访。