5种淋巴结转移分期标准预测肝门部胆管癌预后的应用价值  

Application value of five lymph node staging methods in predicting prognosis of perihilar cholangiocarcinoma

作　　者：陈潇远 毛谅[2] 杨翼飞 伏旭[2] 严笑鹏[2] 蔡正华 周铁[2] 凡银银 张静[2] 仇毓东[1] Chen Xiaoyuan;Mao Liang;Yang Yifei;Fu Xu;Yan Xiaopeng;Cai Zhenghua;Zhou Tie;Fan Yinyin;Zhang Jing;Qiu Yudong(Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University,Nanjing 210008,China;Department of Hepatobiliary and Pancreatic Surgery,Nanjing Drum Tower Hospital,the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,210008 [2]南京大学医学院附属鼓楼医院肝胆胰外科,210008

出　　处：《中华消化外科杂志》2021年第1期110-117,共8页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(31971518);江苏省医学重点人才项目(ZDRCA2016057)。

摘　　要：目的探讨美国癌症联合会(AJCC)第8版肿瘤TNM分期系统N分期、阳性淋巴结数目(pLN)、阴性淋巴结数目(nLN)、淋巴结转移率(LNR)和阳性淋巴结对数比(LODDS)5种淋巴结转移分期标准预测肝门部胆管癌(PHCC)预后的应用价值。方法采用回顾性队列研究方法。收集2004―2015年美国监测、流行病学和最终结果(SEER)数据库669例PHCC病人的临床病理资料;男406例,女263例;年龄为(66±11)岁,年龄范围为29~92岁。观察指标:(1)PHCC病人预后影响因素分析。(2)PHCC病人随访和生存情况。(3)5种淋巴结转移分期标准N1期和N2期病人预后比较。(4)5种淋巴结转移分期标准预测病人预后的准确性。正态分布的计量资料以x±s表示,偏态分布的计量资料以M(范围)表示。计数资料以绝对数和百分比表示。采用Kaplan-Meier法计算生存率并绘制生存曲线。单因素生存分析采用Log-rank检验,多因素生存分析采用COX比例风险模型。采用X-tile 3.6.1软件确定pLN、nLN、LNR和LODDS的最佳截断值并将其转化为分类变量。将有区域淋巴结转移病人,根据AJCC第8版肿瘤TNM分期系统N分期及由X-tile软件计算5种分期标准的最佳截断值分别分为N1期和N2期。计算赤池信息量准则(AIC)、一致性指数(C-index)和1、3、5年受试者工作特征曲线下面积(AUC)比较不同分期标准的评估效能。结果(1)PHCC病人预后影响因素分析。单因素分析结果显示:肿瘤分化程度、肿瘤长径、T分期、区域淋巴结转移是影响PHCC病人预后的相关因素(χ2=17.893,10.196,25.177,76.707,P<0.05);多因素分析结果显示:肿瘤为低-未分化、T分期为pT3~pT4期、区域淋巴结转移是病人预后的独立危险因素(风险比=1.384,1.262,2.067,95%可信区间为1.145~1.673,1.032~1.543,1.698~2.515,P<0.05)。(2)PHCC病人随访及生存情况:669例病人均获得随访。病人肿瘤特异性生存时间为1~167个月,中位生存时间为26个月,1、3、5年肿瘤Objective To investigate the application value of 5 different lymph node staging methods in predicting prognosis of perihilar cholangiocarcinoma(PHCC),including the pN stage of American Joint Committee on Cancer(AJCC)8th edition TNM staging system,the number of positive lymph nodes(pLN),the number of negative lymph nodes(pLN),lymph node ratio(LNR),and log odds of metastatic lymph nodes(LODDS).Methods The retrospective cohort study was conducted.The clinicopathological data of 669 PHCC patients from 2004 to 2015 in the Surveillance,Epidemiology,and End Results(SEER)database of America were collected.There were 406 males and 263 females,aged(66±11)years,with a range from 29 to 92 years.Observation indicators:(1)prognostic factor analysis of PHCC patients;(2)follow-up and survival of PHCC patients;(3)comparison of prognosis between patients in N1 stage and patients in N2 stage grouped by 5 different lymph node staging methods;(4)accuracy of 5 different lymph node staging methods in predicting prognosis of PHCC patients.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers and percentages.The Kaplan-Meier method was used to calculate survival rates and draw survival curves.The Log-rank test was used for univariate survival analysis.Multivariate survival analysis was performed using the COX proportional hazard model.X-tile 3.6.1 software was used to determine the optimal cut-off values of pLN,nLN,LNR and LODDS,and they were converted to categorical variables.Patients with regional lymph node metastasis were divided into patients in N1 stage and N2 stage based on pN stage of the AJCC 8th edition TNM staging system and optimal cut-off values of pLN,nLN,LNR and LODDS in X-tile software.Akaike information criterion(AIC),Harrell's Consistency Index(C-index)and 1-,3-,5-year area under receiver operating curve(AUROC)were calculated to compare prognostic performance of different staging me

关 键 词：胆道肿瘤 肝门部胆管癌 影响因素 区域淋巴结转移 阳性淋巴结对数概率 监测、流行病学和最终结果数据库 

分 类 号：R735.7[医药卫生—肿瘤]