512例胆管细胞癌的临床及预后特点  

Clinical and prognostic features of 512 cases of cholangiocarcinoma

作　　者：邝曾书瑜 饶乐 罗碧源 罗丽华 刘先领[1] KUANG-ZENG Shuyu;RAO Le;LUO Biyuan;LUO Lihua;LIU Xianling(Department of Oncology,Second Xiangya Hospital,Central South University,Changsha 410011;Department of Oncology,331 Hospital of Zhuzhou,Zhuzhou Hunan 412002;Department of Radiotherapy,Chinese PLA General Hospital,Beijing 100080;Department of Oncology,Central Hospital of Enshi Autonomous Prefecture,Enshi Hubei 445000,China)

机构地区：[1]中南大学湘雅二医院肿瘤科,长沙410011 [2]株洲市三三一医院肿瘤科,湖南株洲412002 [3]中国人民解放军总医院放疗科,北京100080 [4]恩施州中心医院肿瘤科,湖北恩施445000

出　　处：《中南大学学报（医学版）》2020年第11期1283-1290,共8页Journal of Central South University ：Medical Science

摘　　要：目的:胆管细胞癌(cholangiocarcinoma,CCA)恶性程度较高,总体预后较差,初诊时分期较晚,治疗手段有效率欠佳。本研究探索影响CCA发生、发展的临床特点及预后相关因素,以期为CCA的早期诊断及临床治疗提供潜在的手段。方法:回顾性分析中南大学湘雅二医院2002年以来经病理确诊且临床资料完善的512例CCA患者的病历资料。利用Kaplan-Meier法绘制生存曲线、log-rank进行单因素分析,多元Cox回归法对有意义的变量进行多因素分析。结果:CCA发病率≤60岁者高于>60岁者(61.13%vs 38.87%),男性略高于女性(52.54%vs 47.46%),糖类抗原19-9(carbohydrate antigen 19-9,CA19-9)≥35μg/L者占66.21%,病理分期Ⅲ和Ⅳ期患者居多(分别占49.22%和17.58%)。单因素分析发现ALB,ALP,CA19-9等因素与预后相关,多因素Cox生存分析发现ALP,CA19-9,肿瘤最大直径等是CCA预后独立影响因素。结论:CCA发病率≤60岁人群较高,初诊时分期较晚,CA19-9是较为敏感的实验室指标。ALP,CA19-9,肿瘤最大直径,合并子瘤,肝硬化及TNM分期是影响CCA预后的独立因素。Objective: Cholangiocarcinoma(CCA) is an aggressive malignant tumor with a poor overall prognosis. Given that CCA is often diagnosed at the late stage, the current treatments are less effective for most local advanced patients leading to high CCA mortality. This study aims to explore the clinical characteristics and prognostic factors affecting the occurrence and development of CCA and to provide potential methods for early diagnosis and clinical treatment of CCA.Methods: We retrospectively analyzed the medical records of 512 patients with CCA who had been diagnosed by pathology and had completely clinical data in the Second Xiangya Hospital of Central South University in the past 16 years. The clinical features and prognosis related factors that affect the occurrence and development of CCA were investigated. Survival curves were plotted by the Kaplan-Meier method. P-values were calculated by log-rank for univariate analysis, and multivariate Cox regression was used to analyze multivariate analysis of meaningful variables.Results: The incidence of CCA among ≤60 years old people was higher than of that >60 years old one(61.13% vs 38.87%), and was greater in men than women(52.5% vs 47.5%).Carbohydrate antigen 19-9(CA19-9) level ≥35 μg/L accounted for 66.21%. The single tumor accounted for 86.91%, and patients in pathological stage Ⅲ and Ⅳ accounted for 49.22% and 17.58%, respectively. Univariate analysis showed that ALB, ALP, CA19-9, and other factors were relevant to the prognosis. The results of multivariate analysis showed that ALP, CA19-9, tmaximum tumor diameter, and other factors were significant prognostic predictors.Conclusion: The incidence of CCA is higher in ≤60 years old people, and the stage is later at the initial diagnosis. CA19-9 level is a sensitive laboratory indicator. ALP, CA19-9,maximum tumor diameter, merged tumor, cirrhosis, and TNM stage are independent prognostic factors for CCA.

关 键 词：胆管细胞癌 临床特点 预后分析 

分 类 号：R735.8[医药卫生—肿瘤]