肿瘤负荷评分联合淋巴结分期对肝内胆管细胞癌患者术后生存预测价值  

Predictive value of tumor burden score combined with lymph node staging for postoperative survival of intrahepatic cholangiocarcinoma patients

作　　者：杨发才 游川[2] 雷正清 李伟男[2] 段安琪 邱应和 李敬东[2] 程张军 Yang Facai;You Chuan;Lei Zhengqing;Li Weinan;Duan Anqi;Qiu Yinghe;Li Jingdong;Cheng Zhangjun(Center for Hepatobiliary and Pancreatic Diseases,Zhongda Hospital,Southeast University School of Medicine,Nanjing 210009,China;DepartmentⅠof Hepatobiliary Surgery,Laboratory of Minimally Invasive Surgery for Hepatobiliary and Pancreatic Diseases,Affiliated Hospital of North Sichuan Medical College,Institute of Hepatobiliary Pancreatic and Intestinal Diseases of North Sichuan Medical College,Nanchong 637000,China;DepartmentⅡof Hepatobiliary Surgery,Eastern Hepatobiliary Surgery Hospital,Naval Military Medical University,Shanghai 200438,China)

机构地区：[1]东南大学医学院中大医院肝胰胆中心,南京210009 [2]川北医学院附属医院肝胆外一科,川北医学院附属医院肝胆胰微创技术实验室,川北医学院肝胆胰肠研究所,四川省南充市637000 [3]海军军医大学第三附属医院胆道二科,上海200438

出　　处：《中华肝脏外科手术学电子杂志》2023年第4期389-394,共6页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：国家自然科学基金(81871988,82002584)。

摘　　要：目的探讨肿瘤负荷评分(TBS)联合淋巴结分期(TBS-N分期)对肝内胆管细胞癌(ICC)患者术后生存的预测价值。方法回顾性分析2013年1月至2019年12月在东南大学医学院中大医院、上海东方肝胆外科医院和川北医学院附属医院行肝切除术的335例ICC患者临床资料。其中男169例,女166例;年龄23~87岁,中位年龄62岁。患者均签署知情同意书,符合医学伦理学规定。计算患者的TBS,结合TBS评分及有无淋巴结转移将患者分为Ⅰ、Ⅱ和Ⅲ期。采用ROC曲线分析TBS-N分期对ICC患者肝切除术后预后的预测能力。采用Cox比例风险回归模型分析ICC患者肝切除术后预后的危险因素。结果TBS最佳界值为4.22,其中TBS-N分期Ⅰ期84例,Ⅱ期202例,Ⅲ期49例。TBS-N分期与ICC患者的肿瘤直径(F=77.639,P<0.05)、术中出血量(Z=11.385,P<0.05)、HBV感染率(χ^(2)=6.590,P<0.05)、手术切除范围(χ^(2)=9.796,P<0.05)、血管侵犯(χ^(2)=12.332,P<0.05)、TNM分期(P<0.05)、术后并发症(χ^(2)=7.210,P<0.05)有关。Cox多因素分析显示,TBS>4.22、N1分期、肿瘤低分化是ICC患者肝切除术后预后的独立危险因素(HR=1.529,2.100,1.724;P<0.05)。TBS-N分期Ⅰ、Ⅱ和Ⅲ期患者的中位生存时间分别为51.4、22.7和12.0个月,总体生存率差异有统计学意义(χ^(2)=25.797,P<0.05)。TBS、N分期和TBS-N模型预测ICC患者肝切除术后预后的ROC曲线下面积分别为0.596、0.602和0.660。结论TBS、N分期均是ICC患者肝切除术后预后的独立影响因素,TBS-N分期能更好地评估ICC肝切除术后患者预后,预测价值优于单独的TBS和N分期。Objective To explore the predictive value of tumor burden score(TBS)combined with lymph node staging(TBS-N staging)for postoperative survival of patients with intrahepatic cholangiocarcinoma(ICC).Methods Clinical data of 335 ICC patients who underwent hepatectomy in Zhongda Hospital of Southeast University School of Medicine,Eastern Hepatobiliary Surgery Hospital and Affiliated Hospital of North Sichuan Medical College from January,2013 to December,2019 were retrospectively analyzed.Among them,169 patients were male and 166 female,aged from 23 to 87 years,with a median age of 62 years.The informed consents of all patients were obtained and the local ethical committee approval was received.The TBS of all patients was calculated.All the patients were divided into stageⅠ,ⅡandⅢaccording to TBS score and lymph node metastasis.The predictive ability of TBS-N staging for clinical prognosis of ICC patients after hepatectomy was analyzed by the receiver operating characteristic(ROC)curve.The risk factors of clinical prognosis of ICC patients after hepatectomy were identified by Cox proportional hazard regression model.Results The optimal cut-off value of TBS was 4.22,including84 cases of TBS-N stageⅠ,202 cases of stageⅡand 49 cases of stageⅢ.TBS-N staging was correlated with tumor diameter(F=77.639,P<0.05),intraoperative blood loss(Z=11.385,P<0.05),HBV infection rate(χ^(2)=6.590,P<0.05),surgical resection range(χ^(2)=9.796,P<0.05),vascular invasion(χ^(2)=12.332,P<0.05),TNM staging(P<0.05)and postoperative complications(χ^(2)=7.210,P<0.05)of ICC patients.Cox multivariate analysis showed that TBS>4.22,N1 stage and poor tumor differentiation were the independent risk factors for clinical prognosis of ICC patients after hepatectomy(HR=1.529,2.100,1.724;P<0.05).The median overall survival of patients with TBS-N stageⅠ,ⅡandⅢwas 51.4,22.7 and 12.0 months,respectively,where significant differences were observed(χ^(2)=25.797,P<0.05).The area under ROC curve(AUC)of TBS,N staging and TBS-N model for predicting

关 键 词：肝肿瘤 肝内胆管细胞癌 肿瘤负荷评分 淋巴结分期 预后 

分 类 号：R735.7[医药卫生—肿瘤]