基于中介分析预测术前血清学肿瘤标志物阳性数对肝内胆管癌患者手术方式及预后的影响  

Predict the effect of the number of positive preoperative serum tumor markers on the surgical method and prognosis of intrahepatic cholangiocarcinoma patients based on mediation analysis

作　　者：李宗龙 陈家璐 唐玥 覃德龙 陈晨[2] 邱应和 吴泓[4] 何宇 毛先海[6] 翟文龙[7] 李敬东[8] 梁霄[9] 孙传东[10] 马凯[10] 耿智敏[2] 汤朝晖[1] 全志伟[1] Li Zonglong;Chen Jialu;Tang Yue;Qin Delong;Chen Chen;Qiu Yinghe;Wu Hong;He Yu;Mao Xianhai;Zhai Wenlong;Li Jingdong;Liang Xiao;Sun Chuandong;Ma Kai;Geng Zhimin;Tang Zhaohui;Quan Zhiwei(Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Biliary Tract Surgery,the Third Affliated Hospital of Naval Medical University,Shanghai 200433,China;Center of Liver Surgery and Liver Transplantation,the First Affiliated Hospital of Sichuan University,Chengdu 610041,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Hepatobiliary Surgery,Hunan Provincial People's Hospital,Changsha 410005,China;Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Hepatobiliary Surgery,Afiliated Hospital of North Sichuan Medical College,Nanchong 637000,China;Department of Hepatobiliary and Pancreatic Surgery,Sir Run Run Shaw Hospital,School of Medicine,Zhejiang University,Hangzhou 310020,China;Department of Hepatobiliary and Pancreatic Surgery,the Afiliated Hospital of Qingdao University,Qingdao266003,China)

机构地区：[1]上海交通大学医学院附属新华医院普外科,上海200092 [2]西安交通大学第一附属医院肝胆外科,西安710061 [3]海军军医大学第三附属医院胆道外科,上海200433 [4]四川大学华西医院肝脏外科与肝脏移植中心,成都610041 [5]陆军军医大学附属第一医院肝胆外科,重庆400038 [6]湖南省人民医院肝胆外科,长沙410005 [7]郑州大学第一附属医院肝胆胰外科,郑州450052 [8]川北医学院附属医院肝胆外科,南充637000 [9]浙江大学医学院附属邵逸夫医院肝胆胰外科,杭州310020 [10]青岛大学附属医院肝胆胰外科,青岛266003

出　　处：《中华外科杂志》2024年第7期685-696,共12页Chinese Journal of Surgery

基　　金：国家自然科学基金(81772521);上海交通大学医学院附属新华医院院级临床研究培育基金(17CSK06);上海交通大学医学院多中心临床研究(DLY201807)。

摘　　要：目的探讨术前血清学肿瘤标志物阳性数对肝内胆管癌患者手术方式及预后的影响。方法回顾性病例系列研究。回顾性收集2010年10月至2019年4月我国10家三级甲等医院收治的548例根治性切除术后肝内胆管癌患者的相关数据。男性277例,女性271例;年龄(57.8±10.2)岁(范围:23~84岁)。426例(77.7%)患者术前血清学肿瘤标志物至少有一项阳性。收集的数据包括4项术前血清学肿瘤标志物检测结果、其他术前指标(前驱症状5项、既往病史6项、术前血清学指标8项、术前影像学指标5项、术前病理学检查指标14项)、患者基线数据(性别和年龄)、手术方式和预后随访数据。将4项术前血清学肿瘤标志物检测结果和手术方式转换为分类变量。利用中介分析方法,将术前血清学肿瘤标志物阳性数作为处理变量,手术方式为中介变量,生存时间为结局变量,采用单因素和多因素分析的方法筛选同时是手术方式和患者独立预后因素的其他术前指标作为协变量,分析中介效应。结果纳入研究的548例患者中,176例(32.1%)患者行单纯部分肝切除术,151例(27.5%)患者行单纯半肝切除术,221例(40.3%)患者行部分肝切除或半肝切除术联合其他治疗方法。单因素和多因素分析结果显示,术前血清学肿瘤标志物阳性数、肝内胆管扩张、门静脉侵犯、分化程度、病理学类型、血管侵犯、T分期、N分期和肿瘤最大径是手术方式的独立影响因素(P值均<0.05);肝内胆管扩张、分化程度和T分期是肝内胆管癌患者的独立预后因素(P值均<0.05)。将肝内胆管扩张、分化程度和T分期作为协变量纳入中介效应模型,结果显示,术前血清学肿瘤标志物阳性数对肝内胆管癌患者的生存时间有负向预测作用(β=-0.092,P=0.039),同时对所采用的手术方式具有正向预测作用(β=0.244,P<0.01);将手术方式代入模型后,术前血清学肿瘤标志物阳性数对肝内Objective:To investigate the effect of the number of positive preoperative serological tumor markers on the surgical approach and prognosis of patients with intrahepatic cholangiocarcinoma.Methods:This is a retrospective case-series study.Data from 548 patients with intrahepatic cholangiocarcinoma after radical resection from October 2010 to April 2019 were retrospectively collected in 10 hospitals of China.There were 277 males and 271 females with an age of(57.8±10.2)years(range:23 to 84 years).Four hundred and twenty-six patients(77.7%)had at least one positive preoperative serum tumor marker.The data collection included the results of 4 preoperative serological tumor markers,other preoperative indicators(5 prodromal symptoms,6 medical history,8 preoperative serological indicators,5 preoperative imaging indicators,and 14 preoperative pathological examination indicators),baseline data(gender and age),surgical methods,and prognostic follow-up data.Four preoperative results of serologic tumor marker and surgical procedure were converted into categorical variables.The number of positive preoperative serum tumor markers was used as the treatment variable,the surgical method was used as the mediating variable,and the survival time was used as the outcome variable.Univariate and multivariate analysis were used to screen for other preoperative indicators which were independent factors that influenced the surgical procedure and the prognosis of patients as covariates to analyze the mediating effect.Results:Of the 548 patients included in the study,176 patients(32.1%)underwent partial hepatectomy,151 patients(27.5%)underwent hemihepatectomy,and 221 patients(40.3%)underwent partial hepatectomy or hemihepatectomy combined with other treatments.The results of the univariate and multivariate analysis showed that the number of positive serum tumor markers,intrahepatic bile duct dilatation,portal vein invasion,pathological differentiation,pathological type,vascular invasion,T stage,N stage and maximum tumor diameter were inde

关 键 词：肝肿瘤 预后 中介分析 肿瘤标志物 肝内胆管癌 

分 类 号：R735.7[医药卫生—肿瘤]