炎症和肿瘤指标预后评分在肝内胆管癌中的预测价值  

Predictive value of prognostic inflammatory and tumor score in intrahepatic cholangiocarcinoma

作　　者：马炳奇[1] 孟慧娟[2] 董小锋[3] 高学磊 吴雨宁 张伟[4] 李世平[1] 申安[1] Ma Bingqi;Meng Huijuan;Dong Xiaofeng;Gao Xuelei;Wu Yuning;Zhang Wei;Li Shiping;Shen An(Department of Hepatopancreatobiliary Surgery,Affiliated Hospital of Weifang Medical University,Weifang 261031,China;Department of Dermatology,Affiliated Hospital of Weifang Medical University,Weifang 261031,China;Department of Hepatobiliary,Pancreas and Spleen Surgery,the People's Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences),Nanning 530021,China;Department of Hepatobiliary Surgery,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300060,China)

机构地区：[1]潍坊医学院附属医院肝胆胰外科,潍坊261031 [2]潍坊医学院附属医院皮肤科,潍坊261031 [3]广西壮族自治区人民医院(广西医学科学院)肝胆胰脾外科,南宁530021 [4]天津医科大学肿瘤医院肝胆肿瘤科,天津300060

出　　处：《中华肝脏病杂志》2022年第7期777-783,共7页Chinese Journal of Hepatology

基　　金：山东省医药卫生科技发展计划项目(202004011537);潍坊市科学技术发展计划(医学类)(2020YX085);医学科研发展基金项目——临床与基础研究专项(TB205004);潍坊医学院附属医院科研创新计划项目(2022BSQD07)。

摘　　要：目的对比分析不同炎症因子和肿瘤标志物在肝内胆管癌(ICC)中的预测价值,提出新的有效的术前预后评分系统。方法分别选取于天津医科大学肿瘤医院和潍坊医学院附属医院行根治性手术治疗的102例和72例ICC患者作为实验组和验证组,收集临床病理和随访资料。采用Cox比例风险模型分析不用类型预后指标的预测价值,并通过秩和检验、χ^(2)检验或者Fisher精确概率法分析预后指标与临床病理资料的关系。结果在直接炎症因子、肿瘤标志物和联合炎症因子中,炎症预后指标(PII)、糖类抗原(CA)19-9和系统炎症评分(SIS)分别是ICC患者术后生存结局的最有价值的预测因子。提出了一个新的针对ICC的预后评分系统——炎症和肿瘤指标预后评分(PITS),它将PII和CA19-9二个指标纳入评分标准对患者预后进行分层。PITS是ICC患者术后无瘤生存期和总生存期的独立预测因子,且高级别PITS患者肿瘤分期更晚、血管侵犯的频率更高。结论PITS是一个高效的针对ICC患者的预后评分系统。推荐使用PITS对ICC患者在术前进行预后分层。Objective To compare and analyze the predictive value of different inflammatory factors and tumor markers in intrahepatic cholangiocarcinoma and to develop a new and effective preoperative prognostic scoring system.Methods 102 and 72 cases with intrahepatic cholangiocarcinoma who underwent radical surgery in Tianjin Medical University Cancer Institute and Hospital and the Affiliated Hospital of Weifang Medical University were selected as the experimental group and the validation group,respectively.Clinicopathological and follow-up data were collected.Cox proportional-hazards model was used to analyze the predictive value of different prognostic markers.The relationship between prognostic markers and clinicopathological data was analyzed by rank sum test,χ^(2) or Fisher's exact test.Results Among the direct inflammatory factors,tumor markers and combined inflammatory factors,prognostic inflammatory index(PII),carbohydrate antigen(CA)19-9 and systemic inflammation score(SIS)were the most significant predictive factors for postoperative survival outcomes in patients with intrahepatic cholangiocarcinoma.The prognostic inflammatory and tumor score(PITS)was proposed as a new prognostic scoring system for intrahepatic cholangiocarcinoma.PII and CA19-9 were included into the scoring criteria for prognostic stratification of patients.PITS was an independent predictor of tumor-free survival and overall survival in patients with intrahepatic cholangiocarcinoma.Patients with high-grade PITS had later tumor grade and higher frequency of vascular invasion.Conclusion PITS is highly effective prognostic scoring system for patients with intrahepatic cholangiocarcinoma.In addition,PITS is recommended for preoperative prognostic stratification in patients with intrahepatic cholangiocarcinoma.

关 键 词：肝内胆管癌 炎症和肿瘤指标预后评分 预后 炎症因子 肿瘤标志物 

分 类 号：R735.8[医药卫生—肿瘤]