不同组织学分型肝内胆管癌的临床病理特征及预后影响因素  

Clinicopathological characteristics and prognostic factors of different histological subtypes of intra-hepatic cholangiocarcinoma

作　　者：陈卓妙语 韦鹏程 罗臻 罗永婧 朱继业[1] 李照[1] Chen Zhuomiaoyu;Wei Pengcheng;Luo Zhen;Luo Yongjing;Zhu Jiye;Li Zhao(Department of Hepatobiliary Surgery,Peking University People′s Hospital,Beijing100044,China)

机构地区：[1]北京大学人民医院肝胆外科,北京100044

出　　处：《中华消化外科杂志》2024年第11期1423-1429,共7页Chinese Journal of Digestive Surgery

基　　金：首都卫生发展科研专项(首发2022-2-4084)。

摘　　要：目的探讨不同组织学分型肝内胆管癌(ICC)的临床病理特征及预后影响因素。方法采用回顾性队列研究方法。收集2015年1月至2023年12月北京大学人民医院收治的171例初次行根治性手术ICC患者的临床病理资料;男94例,女77例;年龄为60(53~68)岁。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验。偏态分布的计量资料以M(范围)表示,组间比较采用Mann-Whitney U检验。计数资料以绝对数表示,组间比较采用χ^(2)检验或Fisher确切概率法。采用Kaplan-Meier法绘制生存曲线并计算生存率,Log-rank检验进行生存分析。单因素和多因素分析采用COX逐步回归模型。结果(1)不同组织学分型ICC临床病理特征比较。术后组织病理学检查结果显示:171例ICC患者中,大胆管型76例,小胆管型95例。大胆管型和小胆管型ICC患者合并肝内胆管结石比较,差异有统计学意义(P<0.05);合并病毒性肝炎,CA19-9水平(>39 U/mL比≤39 U/mL、>1000 U/mL比>39~1000 U/mL),肿瘤生长方式,肿瘤周围神经侵犯比较,差异均有统计学意义(χ^(2)=8.906,18.208,5.689,43.886,6.178,P<0.05)。(2)不同组织学分型ICC预后分析。171例患者中,130例获得随访,随访时间为22(16~43)个月。130例获得随访的患者中,大胆管型和小胆管型ICC分别为63和67例,5年总生存率分别为12.60%和43.70%,两者比较,差异有统计学意义(χ^(2)=5.799,P<0.05)。(3)影响行根治性切除术ICC患者的预后因素分析。多因素分析结果显示:肿瘤周围神经侵犯、淋巴结转移是影响行根治性切除术ICC患者总生存率的独立危险因素(风险比=0.447,0.383,95%可信区间为0.259~0.771,0.225~0.651,P<0.05)。结论大胆管型和小胆管型ICC在临床病理特征和预后方面均存在差异,肿瘤周围神经侵犯、淋巴结转移是影响行根治性切除术ICC患者总生存率的独立危险因素。Objective To investigate the clinicopathological characteristics and prognostic factors of different histological subtypes of intrahepatic cholangiocarcinoma(ICC).Methods The retrospective cohort study was conducted.The clincopathological data of 171 patients with ICC who underwent initial curative resection in Peking University People′s Hospital from January 2015 to December 2023 were collected.There were 94 males and 77 females,aged 60(range,53-68)years.Measurement data with normal distribution were expressed as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were expressed as M(range),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi‐square test or Fisher exact probability.The Kaplan‐Meier method was used to draw survival curve and calculate survival rates,and the Log-rank test was used for survival analysis.The COX stepwise regression model was used for univariate and multivariate analyses.Results(1)Comparison of clinicopathological characteristics of different histological subtypes of ICC.Results of postoperative histopathological examination showed that of the 171 ICC patients,there were 76 cases of large duct type ICC and 95 cases of small duct type ICC.There was a significant difference in cases with concomitant intrahepatic biliary stone between patients with different histological subtypes of ICC(P<0.05),and there were significant differences in cases with concomitant viral hepatitis,cases with CA19-9>39 U/mL versus CA19-9≤39 U/mL,cases with CA19-9>1000 U/mL versus CA19-9>39-1000 U/mL,tumor gross morphology,and tumor peri-neural invasion between patients with different histological subtypes of ICC(χ^(2)=8.906,18.208,5.689,43.886,6.178,P<0.05).(2)Prognostic analysis of different histological subtypes of ICC.Of the 171 patients,130 cases were followed up for 22(range,16-43)months,including

关 键 词：胆道肿瘤 肝内 组织学分型 临床病理特征 预后 危险因素 

分 类 号：R735.7[医药卫生—肿瘤]