肝移植治疗肝内胆管细胞癌临床疗效的多中心研究  

Clinical efficacy of liver transplantation for intrahepatic cholangiocarcinoma:a multicenter study

作　　者：孙大伟[1] 蒋文涛[2] 钟林 蔡金贞 郭文治[5] 吕国悦[1] Sun Dawei;Jiang Wentao;Zhong Lin;Cai Jinzhen;Guo Wenzhi;Lyu Guoyue(Department of Hepatobiliary and Pancreatic Surgery,General Surgery Center,First Hospital of Jilin University,Liver Transplantation Center of Jilin University,Changchun 130021,China;Departement of Liver Transplantation,Tianjin First Central Hospital,Tianjin 300190,China;Department of General Surgery,First Peoples'Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200025,China;Department of Organ Transplantation Center,the Affiliated Hospital of Qingdao University,Qingdao 266075,Shandong Province,China;Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]吉林大学第一医院普通外科中心肝胆胰外一科、吉林大学肝移植中心,长春130021 [2]天津市第一中心医院肝移植科,天津300190 [3]上海交通大学医学院附属第一人民医院普通外科,上海200025 [4]青岛大学附属医院器官移植中心,青岛266075 [5]郑州大学第一附属医院肝胆胰外科,郑州450052

出　　处：《中华消化外科杂志》2023年第2期230-235,共6页Chinese Journal of Digestive Surgery

基　　金：吉林省科技创新基地(平台)建设项目(YDZJ202202CXJD010)。

摘　　要：目的探讨肝移植治疗肝内胆管细胞癌(ICC)的临床疗效。方法采用回顾性队列研究方法。收集2005年9月至2021年12月吉林大学第一医院等国内5家医学中心收治的22例行肝移植ICC患者的临床病理资料;男18例,女4例;年龄为57(38~71)岁。观察指标:(1)ICC患者临床病理特征。(2)随访情况。(3)预后情况。偏态分布的计量资料以M(范围)表示。计数资料以绝对数或百分比表示。采用Kaplan-Meier法绘制生存曲线,Log-Rank检验进行生存分析。结果(1)ICC患者临床病理特征。22例患者中,20例移植前确诊ICC;7例有乙型病毒性肝炎病史,1例有原发性硬化性胆管炎病史;7例移植前有肿瘤治疗史;肝功能Child-Pugh分级A、B、C级分别为7、6、9例;16例术前CA19-9>40 U/mL;14例肿瘤数目为单发;11例肿瘤位于右半肝、6例位于左半肝+右半肝、5例位于左半肝;9例肿瘤侵犯脉管;肿瘤均为中、低分化;9例有肝硬化改变;4例发生淋巴结转移;10例肿瘤负荷满足米兰标准;22例患者肿瘤长径为4.5(1.5~8.0)cm。(2)随访情况。22例患者均获得随访,随访时间为15(3~207)个月。22例患者中,9例肿瘤复发,8例死亡。(3)预后情况。22例ICC患者肝移植后1年总生存率、1年无瘤生存率分别为72.73%、68.18%。亚组分析结果显示:10例满足米兰标准和12例超出米兰标准ICC患者肝移植后总生存、无瘤生存情况比较,差异均有统计学意义(风险比=0.13,0.26,95%可信区间为0.03~0.53,0.08~0.82,P<0.05)。进一步分析结果显示:12例超出米兰标准ICC患者中,5例术前行肿瘤降期治疗和7例未行肿瘤降期治疗患者肝移植后总生存、无瘤生存情况比较,差异均有统计学意义(风险比=0.18,0.14,95%可信区间为0.04~0.76,0.04~0.58,P<0.05)。结论满足米兰标准ICC患者肝移植预后效果明显优于超出米兰标准患者,而对超出米兰标准ICC患者积极行肝移植前降期治疗可显著改善患者预后。Objective To investigate the clinical efficacy of liver transplantation for intra-hepatic cholangiocarcinoma.Methods The retrospective cohort study was conducted.The clinico-pathological data of 22 patients with intrahepatic cholangiocarcinoma who underwent liver trans-plantation in the 5 medical centers,including First Hospital of Jilin University,et al,from September 2005 to December 2021 were collected.There were 18 males and 4 females,aged 57(range,38‒71)years.Observing indicators:(1)clinicopathological characteristics of patients with intrahepatic cholangiocarcinoma;(2)follow-up;(3)prognosis.Measurement data with skewed distribution were represented as M(range).Count data were described as absolute numbers or percentages.The Kaplan-Meier method was used to draw survival curves.The Log-Rank test was used for survival analysis.Results(1)Clinicopathological characteristics of patients with intrahepatic cholangio-carcinoma.Of the 22 patients,20 cases were diagnosed as intrahepatic cholangiocarcinoma before liver transplantation,7 cases had viral hepatitis type B,1 case had primary sclerosing cholangitis,7 cases had tumor treatment before liver transplantation,7 cases,6 cases and 9 cases were classified as grade A,grade B and grade C of the Child-Pugh classification,16 cases had preoperative CA19-9>40 U/mL,14 cases had single tumor,11 cases with tumor located at right lobe of liver,6 cases with tumor located at both left and right lobe of liver,5 cases with tumor located at left lobe of liver,9 cases with tumor vascular invasion.All 22 patients were diagnosed as moderate-poor differentiated tumor.There were 9 cases with liver cirrhosis,4 cases with tumor lymph node metastasis,10 cases with tumor burden within Milan criteria.The tumor diameter of 22 patients was 4.5(range,1.5‒8.0)cm.(2)Follow-up.All 22 patients were followed up for 15(range,3‒207)months.Of the 22 patients,9 cases had tumor recurrence and 8 cases died.(3)Prognosis.The 1-year overall survival rate and 1-year disease-free survival rate of the 2

关 键 词：肝肿瘤 肝移植 预后 米兰标准 降期治疗 

分 类 号：R735.8[医药卫生—肿瘤]