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中华肝脏外科手术学电子杂志

中华肝脏外科手术学电子杂志 ›› 2019, Vol. 08 ›› Issue (01) : 26 -30. doi: 10.3877/cma.j.issn.2095-3232.2019.01.007

所属专题： 文献；

临床研究

肿块型肝内胆管细胞癌手术切除预后影响因素分析
赵向前1,†(), 梁斌1, 张航宇1, 冯健1   
  1. 1. 100853　北京，解放军总医院肝胆外科
  • 收稿日期:2018-10-18 出版日期:2019-02-10
  • 通信作者: 赵向前

Analysis of prognostic impact factors of patients with mass-forming intrahepatic cholangiocarcinoma after surgical resection

Xiangqian Zhao1,†(), Bin Liang1, Hangyu Zhang1, Jian Feng1   

  1. 1. Department of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China
  • Received:2018-10-18 Published:2019-02-10
  • Corresponding author: Xiangqian Zhao
  • About author:
    Corresponding author: Zhao Xiangqian, Email:
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赵向前, 梁斌, 张航宇, 冯健. 肿块型肝内胆管细胞癌手术切除预后影响因素分析[J]. 中华肝脏外科手术学电子杂志, 2019, 08(01): 26-30.

Xiangqian Zhao, Bin Liang, Hangyu Zhang, Jian Feng. Analysis of prognostic impact factors of patients with mass-forming intrahepatic cholangiocarcinoma after surgical resection[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2019, 08(01): 26-30.

目的

探讨肿块型肝内胆管细胞癌（ICC）手术切除预后相关危险因素。

方法

回顾性分析2010年1月至2016年10月在解放军总医院行手术切除的48例肿块型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33例，女15例；年龄29～73岁，中位年龄53岁。肿瘤位于肝右叶37例，肝左叶11例；肿瘤平均直径（6.8±2.6）cm；所有患者均行R0切除。将患者临床病理参数纳入预后影响因素分析，单因素分析采用Kaplan-Meier法和Log-rank检验，多因素分析采用Cox比例风险回归模型。

结果

随访期间死亡28例，存活20例，生存时间3～82个月，中位生存时间20个月，1、3、5年生存率分别为95.7%、50.9%、14.8%。单因素分析显示，HBsAg、肿瘤分化程度、淋巴结转移、脉管受侵是肿块型ICC患者手术切除预后的影响因素（χ2= 4.097，6.415，11.069，9.117；P<0.05）。多因素分析显示，淋巴结转移是影响肿块型ICC患者手术切除预后的独立危险因素（HR=3.306，95%CI：1.184～9.233；P<0.05）。

结论

淋巴结转移是影响肿块型ICC患者手术切除预后的独立危险因素。

关键词: 肝内胆管细胞癌, 肝切除术, 预后, 危险因素
Objective

To investigate the risk factors of clinical prognosis of mass-forming intrahepatic cholangiocarcinoma (ICC) patients after surgical resection.

Methods

Clinical data of 48 patients with mass-forming ICC who underwent surgical resection in PLA General Hospital from January 2010 to October 2016 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 33 patients were male and 15 were female, aged from 29 to 73 years with a median age of 53 years. Tumors were located in the right lobe of the liver in 37 cases and left lobe in 11 cases. The mean tumor diameter was (6.8±2.6) cm. All patients underwent R0 resection. The clinicopathological parameters were included in the analysis of prognostic factors. Kaplan-Meier survival curve and Log-rank test were conducted for univariate analysis. Cox's proportional hazard model was conducted for multivariate analysis.

Results

During the postoperative follow-up, 28 cases died and 20 cases survived. The survival time was 3-82 months with a median survival time of 20 months. The 1-, 3- and 5-year survival rate was 95.7%, 50.9% and 14.8%, respectively. Univariate analysis indicated that HBsAg, degree of tumor differentiation, lymph node metastasis and vascular invasion were the impact factors for the survival prognosis (χ2=4.097, 6.415, 11.069, 9.117; P<0.05). Multivariate analysis revealed that lymph node metastasis was an independent risk factor for the prognosis of patients undergoing surgical resection (HR=3.306, 95%CI: 1.184-9.233; P<0.05).

Conclusion

Lymph node metastasis is an independent risk factor for the clinical prognosis of mass-forming ICC patients after surgical resection.

Key words: Intrahepatic cholangiocarcinoma, Hepatectomy, Prognosis, Risk factors
表1 影响肿块型ICC患者手术切除预后单因素分析（%）
影响因素 例数 1年 3年 5年 χ2值 P值
性别 ? ? ? ? 0.455 0.500
? 男 33 93.8 49.8 18.7 ? ?
? 女 15 90.0 54.0 13.5 ? ?
年龄（岁） ? ? ? ? 0.087 0.768
? ≤53 27 92.3 48.6 21.2 ? ?
? > 53 21 100.0 66.7 10.0 ? ?
HBsAg ? ? ? ? 4.097 0.043
? 阴性 35 97.1 59.0 23.3 ? ?
? 阳性 13 92.3 30.8 0 ? ?
CA19-9 ? ? ? ? 0.137 0.711
? 阴性 26 96.0 53.9 12.9 ? ?
? 阳性 22 95.5 46.0 20.5 ? ?
手术切除范围 ? ? ? ? 0.083 0.773
? 局部 25 96.0 50.6 11.4 ? ?
? 段/叶 23 95.5 51.7 19.4 ? ?
肿瘤直径（cm） ? ? ? ? 3.259 0.071
? ≤7 28 92.9 69.6 16.9 ? ?
? > 7 20 100.0 35.7 8.9 ? ?
肿瘤分化程度 ? ? ? ? 6.415 0.040
? 低分化 20 89.7 34.5 0 ? ?
? 中-低分化 18 100.0 78.0 25.3 ? ?
? 中分化 10 100.0 35.7 35.7 ? ?
淋巴结转移 ? ? ? ? 9.117 0.003
? 阴性 35 85.3 72.5 21.7 ? ?
? 阳性 13 92.3 12.8 0 ? ?
肿瘤位置 ? ? ? ? 0.244 0.621
? 肝左叶 11 100.0 66.7 33.3 ? ?
? 肝右叶 37 94.4 47.8 13.4 ? ?
切缘宽度（cm） ? ? ? ? 0.834 0.361
? ≤1 21 95.2 40.3 16.1 ? ?
? > 1 27 96 57.3 14.6 ? ?
脉管受侵 ? ? ? ? 11.069 0.001
? 无 37 97.1 66.3 10.1 ? ?
? 有 11 90.9 36.4 0 ? ?
图1 肿块型ICC患者手术切除术后Kaplan-Meier生存曲线
表2 影响肿块型ICC患者手术切除预后的多因素分析
影响因素 b SE（b） wald χ2 HR 95%CI P值
HBsAg阳性 0.133 0.504 0.070 1.143 0.425～3.070 0.791
低分化 -0.021 0.358 0.004 0.979 0.485～1.976 0.953
淋巴结转移 1.196 0.524 5.209 3.306 1.184～9.233 0.022
脉管受侵 1.018 0.541 3.542 2.769 0.959～7.995 0.060
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