根治性手术切除治疗早期胆管细胞癌的预后影响因素分析  

Influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma after radical resection

作　　者：黄健 蒋贝格 杨远 顾方明 袁声贤 潘泽亚 HUANG Jian, JIANG Beige, YANG Yuan, et al.(Third Department of Hepatic Surgery, The Third Affiliated Hospital of Second Military Medical University, Shanghai 200438, China)

机构地区：[1]第二军医大学第三附属医院肝外三科,上海200438

出　　处：《临床肝胆病杂志》2018年第10期2157-2163,共7页Journal of Clinical Hepatology

基　　金：国家自然科学基金面上项目(81672721)

摘　　要：目的分析手术治疗早期胆管细胞癌(ICC)患者预后的相关因素。方法收集2013年1月-2014年12月于第二军医大学第三附属医院行根治性手术切除治疗的早期ICC患者共155例,分析其临床病理特点及术后1、2、3年总体生存率及无瘤生存率。采用Cox向前逐步回归单因素及多因素分析影响早期ICC预后相关因素。结果早期ICC多数为中年男性患者,平均直径为(5. 8±2. 5) cm,肝功能多无异常,伴有不同程度CA19-9水平升高,术后病理多为高中分化腺癌。患者术后1、2、3年的总体生存率分别为76. 1%、43. 9%和34. 1%,无瘤生存率分别为50. 3%、25. 0%和18. 1%。Cox多因素分析表明术前高水平CA19-9[风险比(HR)=1. 705,95%可信区间(95%CI):1. 096~2. 652,P=0. 018]、肝硬化(HR=2. 399,95%CI:1. 108~5. 196,P=0. 026)、镜下子灶(HR=1. 918,95%CI:1. 124~3. 272,P=0. 017)、肿瘤细胞分化程度(HR=5. 568,95%CI:2. 591~11. 965,P <0. 000 1)是影响早期ICC总体生存的独立危险因素;肝硬化(HR=2. 142,95%CI:1. 054~4. 353,P=0. 035)、镜下子灶(HR=2. 045,95%CI:1. 250~3. 343,P=0. 004)、肿瘤细胞分化程度(HR=2. 748,95%CI:1. 340~5. 638,P=0. 006)是影响早期ICC无瘤生存的独立危险因素。结论根治性切除术为早期ICC患者首选治疗方法。术前CA19-9≥200 U/ml、肝硬化、镜下子灶、肿瘤细胞分化程度是影响早期ICC预后的独立危险因素。Objective To investigate the influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma（ ICC） after surgical treatment. Methods A total of 155 patients with early-stage ICC who underwent radical resection in The Third Affiliated Hospital of Second Military Medical University from January 2013 to December 2014 were enrolled in this study. Clinicopathological features and 1-,2-,and 3-year overall survival rates and disease-free survival rates after surgery were analyzed. The Cox forward stepwise regression was used for the univariate and multivariate analyses of the influencing factors for the prognosis of early-stage ICC. Results Most patients with early-stage ICC were middle-aged men,with an average tumor diameter of 5. 8 ± 2. 5 cm. Most patients had normal liver function,but there were varying degrees of increase in carbohydrate antigen 19-9（ CA19-9） level. Postoperative pathological examination revealed highly or moderately differentiated adenocarcinoma in most patients. The 1-,2-,and 3-year overall survival rates after surgery were 76. 1%,43. 9%,and 34. 1%,respectively,and the 1-,2-,and 3-year disease-free survival rates were 50. 3%,25. 0%,and 18. 1%,respectively. The Cox multivariate analysis showed that high CA19-9 level before surgery（ hazard ratio [HR]=1. 705,95% confidence interval [CI]： 1. 096-2. 652,P = 0. 018）,liver cirrhosis（ HR = 2. 399,95% CI： 1. 108-5. 196,P = 0. 026）,satellite nodules（ HR = 1. 918,95% CI： 1. 124-3. 272,P = 0. 017）,and degree of tumor cell differentiation（ HR = 5. 568,95% CI：2. 591-11. 965,P〈0. 0001） were independent risk factors for overall survival of patients early-stage ICC. Liver cirrhosis（ HR = 2. 142,95% CI： 1. 054-4. 353,P = 0. 035）,satellite nodules（ HR = 2. 045,95% CI： 1. 250-3. 343,P = 0. 004）,and degree of tumor cell differentiation（ HR = 2. 748,95% CI： 1. 340-5. 638,P = 0. 006） were independent risk factors for disease-free survival of patients early-stage ICC. Conclusion Radic

关 键 词：肝肿瘤 肝切除术 危险因素 预后 

分 类 号：R735.7[医药卫生—肿瘤]