肝内胆管细胞癌术后极早期复发的危险因素  

Risk factors of very early recurrence of intrahepatic cholangiocarcinoma after surgery

作　　者：余承澍 刘红枝 林科灿 林起柱 黄霆峰 周伟平 程张军[3] 楼健颖[4] 郑树国 毕新宇 王剑明[7] 郭伟[8] 李富宇[9] 王坚[10] 郑亚民[11] 李敬东[12] 程石[13] 曾永毅 Chengshu Yu;Hongzhi Liu;Kecan Lin;Qizhu Lin;Tingfeng Huang;Weiping Zhou;Zhangjun Cheng;Jianying Lou;Shuguo Zheng;Xinyu Bi;Jianming Wang;Wei Guo;Fuyu Li;Jian Wang;Yamin Zheng;Jingdong Li;Shi Cheng;Yongyi Zeng(Department of Hepatobiliary Surgery,Mengchao Hepatobiliary Hospital,Fujian Medical University,Fuzhou 350015,China;Department of Hepatobiliary Surgery,Oriental Hepatobiliary Surgery Hospital,Naval Medical University,Shanghai 200438,China;Department of Hepatobiliary Surgery,Zhongda Hospital affiliated to Southeast University,Nanjin·g 210009,China;Department of Hepatobiliary and Pancreatic Surgery,the Second Affiliated Hospital of Zhejiang University School of Medicine,Hangzhou 310009,China;Institute of Hepatobiliary Surgery of the Whole Army,the First Affiliated Hospital of Army Medical University,Chongqing 400038,China;Department of Hepatobiliary Surgery,Peking Union Medical College Cancer Hospital,Chinese Academy of Medical Sciences,Beijing 100021,China;Department of Hepatobiliary and Pancreatic Surgery,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of General Surgery,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Hepatobiliary Surgery,West China Hospital,Sichuan University,Chengdu 610041,China;Department of Hepatobiliary and Pancreatic Surgery,Renji Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China;Department of General Surgery,Xuanwu Hospital,Capital Medical University,Beijing 100053,China;Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Nanchong 617000,China;Department of General Surgery,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]福建医科大学孟超肝胆医院肝胆外科,福州350015 [2]海军军医大学东方肝胆外科医院肝外三科,上海200438 [3]东南大学附属中大医院肝胆外科,南京210009 [4]浙江大学医学院附属第二医院肝胆胰外科,杭州310009 [5]陆军军医大学第一附属医院全军肝胆外科研究所,重庆400038 [6]中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京100021 [7]华中科技大学同济医学院附属同济医院肝胆胰外科,武汉430030 [8]首都医科大学附属北京友谊医院普通外科,北京100050 [9]四川大学华西医院胆道外科,成都610041 [10]上海交通大学医学院附属仁济医院胆胰外科,200127 [11]首都医科大学宣武医院普通外科,北京100053 [12]川北医学院附属医院肝胆外科,四川省南充市617000 [13]首都医科大学附属天坛医院普通外科,北京100070

出　　处：《中华肝脏外科手术学电子杂志》2025年第1期53-59,共7页Chinese Journal of Hepatic Surgery(Electronic Edition)

基　　金：福建省科技重大专项(2021YZ036017);福建省卫生健康委员会中青年科研重大项目(2021ZQNZD013);福州市卫生健康科技创新平台项目(2021-S-wp1)。

摘　　要：目的探讨肝内胆管细胞癌(ICC)患者术后极早期复发(VER)的危险因素。方法回顾性分析2011年12月至2017年12月于福建医科大学孟超肝胆医院、海军军医大学东方肝胆外科医院、东南大学附属中大医院、浙江大学医学院附属第二医院、陆军军医大学第一附属医院、中国医学科学院北京协和医学院肿瘤医院、华中科技大学同济医学院附属同济医院、首都医科大学附属北京友谊医院、四川大学华西医院、上海交通大学医学院附属仁济医院、首都医科大学宣武医院、川北医学院附属医院、首都医科大学附属天坛医院13家中心接受手术治疗的445例ICC患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男270例,女175例;年龄23~88岁,中位年龄57岁。肿瘤直径1.1~20.4 cm,中位直径6.0 cm。以术后6个月内发生ICC复发为标准分为VER组(328例)和非VER组(117例)。采用Logistic单因素和多因素回归分析术后随访资料,生存分析采用Kaplan-Meier法和Log-rank检验。结果Logistic多因素回归分析显示,性别(OR=0.51,95%CI:0.32~0.84)、年龄(OR=0.97,95%CI:0.95~0.99)、肿瘤数目(OR=1.28,95%CI:1.06~1.54)、病理类型(OR=0.40,95%CI:0.16~0.99)、肿瘤最大径(OR=1.10,95%CI:1.02~1.17)是ICC术后患者VER的独立影响因素(P<0.05)。随访6~73个月,中位随访时间21个月。随访期间236例死亡,209例存活。VER组和非VER组术后1、3、5年生存率分别为60.71%、7.14%、0和89.90%、54.40%、25.30%,差异有统计学意义(χ^(2)=88.844,P<0.001)。结论病理类型、肿瘤数目、肿瘤最大径等为ICC术后VER的独立影响因素,VER患者生存预后较差。Objective To investigate the risk factors of very early recurrence(VER)in patients with intrahepatic cholangiocarcinoma(ICC)after surgery.Methods Clinicals data of 445 ICC patients undergoing surgery in Mengchao Hepatobiliary Hospital of Fujian Medical University,Oriental Hepatobiliary Surgery Hospital of Naval Medical University,Zhongda Hospital Affiliated to Southeast University,the Second Affiliated Hospital of Zhejiang University School of Medicine,the First Affiliated Hospital of Army Medical University,Peking Union Medical College Cancer Hospital of Chinese Academy of Medical Sciences,Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology,Beijing Friendship Hospital Affiliated to Capital Medical University,West China Hospital of Sichuan University,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Xuanwu Hospital of Capital Medical University,Affiliated Hospital of North Sichuan Medical College and Beijing Tiantan Hospital Affiliated to Capital Medical University from December 2011 to December 2017 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,270 patients were male and 175 female,aged from 23 to 88 years,with a median age of 57 years.The tumor diameter was ranged from 1.1 to 20.4 cm,with a median diameter of 6.0 cm.According to the recurrence of ICC within postoperative 6 months,they were divided into the VER group(n=328)and non-VER group(n=117).Postoperative follow-up data were assessed by univariate and multivariate Logistic regression analyses.Survival analysis was conducted by using Kaplan-Meier method and Log-rank test.Results Multivariate Logistic regression analysis showed that gender(OR=0.51,95%CI:0.32-0.84),age(OR=0.97,95%CI:0.95-0.99),tumor number(OR=1.28,95%CI:1.06-1.54),pathological type(OR=0.40,95%CI:0.16-0.99)and maximum tumor diameter(OR=1.10,95%CI:1.02-1.17)were the independent risk factors of VER in ICC patients after

关 键 词：肝内胆管细胞癌 肝肿瘤 复发 极早期 危险因素 

分 类 号：R73[医药卫生—肿瘤]