肝内胆管细胞癌根治术后辅助化疗的价值  

Value of adjuvant chemotherapy for intrahepatic cholangiocarcinoma after curative resection

作　　者：胡春秀 余维[1] 魏启春 Hu Chunxiu;Yu Wei;Wei Qichun(Department of Radiation Oncology,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China;Department of Radiation Oncology,Zhejiang Quhua Hospital,Quzhou 324002,China)

机构地区：[1]浙江大学医学院第二附属医院肿瘤放疗科,浙江杭州310009 [2]浙江衢化医院肿瘤放疗科,浙江衢州324002

出　　处：《实用肿瘤杂志》2020年第2期140-144,共5页Journal of Practical Oncology

基　　金：国家自然科学基金(81572952)。

摘　　要：目的探讨辅助化疗对肝内胆管细胞癌根治术后患者的生存影响。方法回顾性分析127例肝内胆管细胞癌根治性切除术后的患者。28例进行术后化疗(化疗组),99例术后未进行化疗。采用SPSS软件的倾向得分匹配功能,按照分期、肿瘤大小、分化程度、切缘、淋巴结转移、年龄和性别的优先级顺序匹配,从99例未化疗患者中找出28例(未化疗组)与接受辅助化疗的患者匹配。未化疗组患者肝内胆管细胞癌根治术后无特殊处理。比较两组患者治疗效果与生存时间。通过Kaplan Meier法分析术后辅助化疗和未辅助化疗患者中位无复发生存时间和中位生存时间。结果56例患者均获得随访,随访时间为2~56个月,中位随访时间为20个月。化疗组患者中位总生存时间为43个月(范围12.0~74.0个月),1、2、3和4年总生存率分别为75.0%、35.7%、17.9%和14.3%;无进展中位生存时间为11.7个月(范围4.0~19.3个月),1、2、3和4年无进展生存率分别为50.0%、14.3%、10.7%和10.7%。未化疗组患者中位总生存时间为15.8个月(范围7.9~23.7个月),1、2、3和4年总生存率分别为53.6%、25.0%、10.7%和3.6%;无进展中位生存时间为10个月(范围2.2~17.7个月),1、2、3和4年无进展生存率分别为39.3%、14.3%、10.7%和3.6%。化疗组和未化疗组的中位总生存时间和中位无进展生存时间比较有延长的趋势,但是差异均无统计学意义(均P>0.05)。结论化疗对肝内胆管癌术后患者显示出一定的生存获益趋势,值得临床进一步研究。Objective To investigate the effect of adjuvant chemotherapy on the survival of intrahepatic cholangiocarcinoma patients after curative resection.Methods One-hundred-and-twenty-seven patients with intrahepatic cholangiocarcinoma(IHCC)who had undergone radical surgery were retrospectively analyzed.Twenty-eight patients(chemotherapy group)who received postoperative chemotherapy were matched by propensity score with those who did not receive chemotherapy in the priority order of stage,tumor size,differentiation,margin,lymph node metastasis,age,and gender.Twenty-eight patients(non-chemotherapy group)were identified from the 99 patients who did not receive chemotherapy.The treatment effect and survival of the two groups were compared.Median progression-free survival(PFS)and median overall survival(OS)were evaluated by Kaplan-Meier in patients with postoperative adjuvant chemotherapy and without adjuvant chemotherapy.Results All 56 patients were followed up for 2 to 56 months,with a median follow-up of 20 months.The median OS for the chemotherapy group was 43 months(range 12.0-74.0 months),and the OS rates at 1,2,3,and 4 years were 75.0%,35.7%,17.9%,and 14.3%,respectively.The median PFS was 11.7 months(range 4.0-19.3 months),and the PFS rates at 1,2,3,and 4 years were 50.0%,14.3%,10.7%,and 10.7%,respectively.For the non-chemotherapy group,the median OS was 15.8 months(range 7.9-23.7 months),and the OS rates at 1,2,3,and 4 years were 53.6%,25.0%,10.7%,and 3.6%,respectively.The median PFS was 10 months(range 2.2-17.7 months),and the PFS rates at 1,2,3,and 4 years were 39.3%,14.3%,10.7%,and 3.6%,respectively.There was no significant difference in both OS and PFS between the chemotherapy and non-chemotherapy groups(P=0.223;P=0.548).Conclusions Chemotherapy shows a certain survival benefit tendency for patients with intrahepatic cholangiocarcinoma after curative resection,which is worthy of further clinical research.

关 键 词：胆管上皮癌/外科学 胆管肿瘤/外科学 胆管 肝内 手术后期间 化学疗法 辅助 综合疗法 存活率 回顾性研究 

分 类 号：R735.8[医药卫生—肿瘤] R730.56[医药卫生—临床医学]