微血管侵犯对肝内胆管细胞癌根治性切除术患者预后的影响  

The prognostic impact of microvascular invasion on patients with intrahepatic cholangiocarcinoma after R0 resections

作　　者：丁光宇 朱小东 施国明[1,2] 沈英皓 蔡加彬[1,2] 孙惠川 周俭[1,2] 樊嘉 黄成[1,2] Ding Guangyu, Zhu Xiaodong, Shi Guoming, Shen Yinghao, Cai Jiabin, Sun Hui- chuan, Zhou Jian, Fan Jia, Huang Cheng.(Department of Liver Surgery and Transplantation, Liver Cancer Institute and Zhongshan Hospital, Fudan University, Shanghai 200032, Chin)

机构地区：[1]复旦大学附属中山医院肝脏外科及肝移植中心 [2]复旦大学肝癌研究所,上海200032

出　　处：《中华肝胆外科杂志》2018年第3期189-193,共5页Chinese Journal of Hepatobiliary Surgery

基　　金：国家自然科学基金（81502006;81572298）

摘　　要：目的探讨微血管侵犯（MVI）对肝内胆管细胞癌（ICC）患者根治性手术预后的影响。方法收集2000年1月至2008年12月复旦大学附属中山医院行根治性切除且经病理证实的359例ICC患者的临床资料，分析与MVI发生相关的临床病理因素，并对ICC患者切除术后的总体生存和无瘤生存进行单因素和多因素分析。结果在纳入本研究的ICC患者中，MVI总发生率为13．6％。MVI与患者术前乙肝感染、肝硬化及肿瘤分化程度相关（均P〈0．05）。MVI组和无MVI组ICC患者切除术后1、3、5年总体生存率分别为50．0％、20．9％、12．2％和63．9％、33．1％、22．0％（P〈0．05），中位生存时间分别为13．0个月和18．5个月（P〈0．05）。MVI组和无MVI组ICC患者切除术后1、3、5年无瘤生存率分别为29．7％、12．7％、8．5％和50．6％、26．9％、18．4％（P〈0．05），中位无瘤生存时间分别为8个月和12．5个月（P〈0．05）。多因素分析显示，MVI是影响患者根治性切除术后无瘤生存的独立危险因素（HR=1．852，95％CI：1．075～3．195，P〈0．05）。结论ICC患者MVI与乙肝感染相关。MVI是ICC患者根治性切除术后肿瘤复发的独立危险因素，但不是总体生存的独立危险因素。MVI对ICC患者手术预后的影响可能不如其对肝细胞癌的影响。Objective To study the clinical impact of microvascular invasion （MVI） on patients with intrahepatic cholangiocarcinoma （ICC） after RO resections. Methods The clinicopathological data of 359 patients with ICC who underwent R0 resection in the Zhongshan Hospital, Fudan University between January 2000 and December 2008 were retrospectively studied. Univariate analysis and multivariate analysis were carried out to study factors related to postoperative survival outcomes and recurrence. The impact of MVI on patients with ICC after RO resection was studied. Results The incidence of MVI was 13.6% in the study cohort. MVI was correlated with HBV infection （ P 〈 0.05）, liver cirrhosis （P 〈 0.05） and tumor dif- ferentiation （ P 〈 O. 05 ）. The 1-, 3-, 5-year overall survival （OS） between the MVI positive and negative groups were 50.0% ,20.9%, 12.2% and 63.9% ,33.1% ,22.0% respectively （P 〈 0.05 ）, and the medi- an survival time was 13 months and 18. 5 months （P 〈0. 05）. The 1-, 3-, 5-year recurrence free survival （RFS） rates between the MVI positive and negative groups were 29.7%, 12. 7%, 8.5% and 50. 6%, 26. 9%, 18.4% , respectively （P 〈0.05）, and the median recurrence free survival time was 8 months and 12. 5 months （P 〈 0. 05 ）. Multivariate analysis showed that MVI was an independent risk factor affecting re- currence after R0 resection （HR 1.852, 95% CI： 1.075 ~3. 195, P〈0.05）. Conclusions The occur- rence of MVI in ICC patients was associated with hepatitis B infection. MVI was an independent risk factor affecting recurrence in ICC patients after R0 resection. However, it was not an independent risk factor of o- verall survival in patients after R0 resection. The clinical impact of MVI on patients with ICC was not as strong as for hepatoeellular carcinoma.

关 键 词：肝内胆管细胞癌 根治性切除 微血管侵犯 预后 

分 类 号：R735.7[医药卫生—肿瘤]