肿瘤负荷评分在获得根治性切除肝内胆管癌患者预后预测中的价值  

Prognostic value of tumor burden score in patients with intrahepatic cholangiocarcinoma after curative hepatic resection

作　　者：陈青 王征 周俭[1,2,3] CHEN Qing;WANG Zheng;ZHOU Jian(Department of Liver Surgery,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Liver Cancer Institute of Fudan University,Key Laboratory of Carcinogenesis and Cancer Invasion,Ministry of Education,Shanghai 200032,China;Institute of Biomedical Sciences,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院肝肿瘤外科,上海200032 [2]复旦大学肝癌研究所,教育部癌变与侵袭原理重点实验室,上海200032 [3]复旦大学生物医学研究院,上海200032

出　　处：《肝胆胰外科杂志》2022年第7期399-405,共7页Journal of Hepatopancreatobiliary Surgery

基　　金：国家自然科学基金项目(81702893,81772578,81830102)。

摘　　要：目的研究肿瘤负荷评分(tumor burden score,TBS)对肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)患者根治性切除术后预后的预测价值。方法回顾性分析2005年1月至2011年12月在复旦大学附属中山医院肝肿瘤外科连续收治的322例行根治性切除术的ICC患者资料,随访截止至2014年4月。采用ROC曲线评价TBS预测总体生存率(OS)的准确性。多因素Cox回归分析影响ICC患者预后的独立因素。结果中位随访时间44.0个月(范围2.7~100.5)。TBS将322例ICC患者分为低、中和高三个预后风险组(104例、176例和42例)。TBS与血清CA199(P=0.004)、术前中性粒细胞/淋巴细胞比值(NLR,P=0.001)、淋巴细胞/单核细胞比值(LMR,P<0.001)、肿瘤最大径(P<0.001)、肿瘤数目(P=0.001)、淋巴结转移(P<0.001)及TNM分期(P<0.001)显著相关。TBS预测ICC患者术后5年OS的曲线下面积(AUC)为0.632(P<0.001),高于NLR≥2.49的AUC(0.603,P=0.002)和LMR≥4.45的AUC(0.596,P=0.003)。Kaplan-Meier生存分析显示,TBS低风险组ICC患者的1、3和5年无复发生存率(RFS)为71.4%、52.1%和40.2%,显著高于TBS中风险组(分别为54.4%、36.6%和32.0%,P=0.0262)与TBS高风险组(分别为26.3%、13.2%和13.2%,P<0.0001)。TBS低风险组ICC患者的1、3和5年OS为87.5%、63.8%和50.6%,显著高于TBS中风险组(分别为73.8%、42.1%和31.0%,P<0.0001)和TBS高风险组(分别为48.9%、31.1%和13.8%,P<0.0001)。多因素Cox回归分析显示,TBS是影响ICC患者术后RFS(HR 2.482,95%CI 1.560~3.947,P<0.001)和OS(HR 4.759,95%CI 2.553~8.870,P<0.001)的独立因素。结论TBS是影响ICC患者根治性切除术后临床预后的独立因素,对ICC患者预后具有良好的预测价值。objective To evaluate the prognostic value of tumor burden score(TBS)in patients with intrahepatic cholangiocarcinoma(ICC)after curative hepatic resection.Methods The clinical data of 322 consecutive ICC patients who underwent a curative hepatic resection at Zhongshan Hospital between Jan.2005 and Dec.2011 were collected.The study was censored on Apr.2014.Time-dependent ROC analysis was conducted to evaluate the ability of TBS in predicting overall survival(OS).Multivariate Cox regression analysis was performed using the Cox proportional hazards regression to determine the independent prognostic factors for ICC patients.Results The median follow-up time was 44.0 months(range 2.7-100.5 months).TBS stratified 322 ICC patients into low,medium and high,three prognostic risk strata(104,176 and 42,respectively).TBS was significantly associated with serum CA199(P=0.004),preoperative NLR(P=0.001),LMR(P<0.001),diameter of the largest tumor nodule(P<0.001),tumor number(P=0.001),lymph node metastasis(P<0.001)and TNM stage(P<0.001),respectively.ROC curve analysis demonstrated that the AUC of TBS for predicting the 5-year OS rate of ICC patients was 0.632,which was significantly better than that of preoperative NLR≥2.49(0.603,P=0.002)and LMR≥4.45(0.596,P=0.003),respectively.Kaplan-Meier survival analysis showed that the 1-,3-,and 5-year RFS in the low TBS group were 71.4%,52.1%and 40.2%,respectively;which were significantly better than those in the medium TBS group(54.4%,36.6%and 32.0%,respectively;P=0.0262)and the high TBS group(26.3%,13.2%and 13.2%,respectively;P<0.0001).The 1-,3-,and 5-year OS in the low TBS group were 87.5%,63.8%and 50.6%,respectively;which were significantly better than those in the medium TBS group(73.8%,42.1%and 31.0%,respectively;P<0.0001)and the high TBS group(48.9%,31.1%and 13.8%,respectively;P<0.0001).Multivariate Cox regression analysis demonstrated that TBS was an independent prognostic factors for postoperative RFS(HR=2.482,95%CI 1.560-3.947,P<0.001)and OS(HR=4.759,95%CI 2.553-8.870,P<0.001)

关 键 词：肝内胆管癌 根治性切除术 肿瘤负荷评分 总体生存率 无复发生存率 

分 类 号：R735.7[医药卫生—肿瘤]