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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 ›› 2021, Vol. 10 ›› Issue (05) : 459 -463. doi: 10.3877/cma.j.issn.2095-3232.2021.05.006

临床研究

术后辅助化疗对肝门部胆管癌切除术后患者预后的影响
严庆1, 冯铭彬1, 朱太峰1, 许磊波1, 刘超1,†()   
  1. 1. 510120　广州，中山大学孙逸仙纪念医院胆胰外科
  • 收稿日期:2021-06-02 出版日期:2021-08-17
  • 通信作者: 刘超
  • 基金资助:
    中山大学临床医学研究5010计划项目(2018008)

Effect of postoperative adjuvant chemotherapy on prognosis of patients with hilar cholangiocarcinoma after surgical resection

Qing Yan1, Mingbin Feng1, Taifeng Zhu1, Leibo Xu1, Chao Liu1,†()   

  1. 1. Department of Biliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China
  • Received:2021-06-02 Published:2021-08-17
  • Corresponding author: Chao Liu
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严庆, 冯铭彬, 朱太峰, 许磊波, 刘超. 术后辅助化疗对肝门部胆管癌切除术后患者预后的影响[J]. 中华肝脏外科手术学电子杂志, 2021, 10(05): 459-463.

Qing Yan, Mingbin Feng, Taifeng Zhu, Leibo Xu, Chao Liu. Effect of postoperative adjuvant chemotherapy on prognosis of patients with hilar cholangiocarcinoma after surgical resection[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(05): 459-463.

目的

探讨术后辅助化疗对肝门部胆管癌切除术后患者预后的影响。

方法

回顾性分析2012年1月至2017年12月在中山大学孙逸仙纪念医院行手术切除治疗的86例肝门部胆管癌患者临床资料。其中男52例，女34例；年龄28~79岁，中位年龄60岁。患者均签署知情同意书，符合医学伦理学规定。根据术后有无辅助化疗，将其分为辅助化疗组（42例）和手术组（44例）。采用1:1倾向性评分匹配（PSM）后进行生存和预后影响因素分析。生存分析采用Kaplan-Meier法和Log-rank检验。患者预后影响因素分析采用Cox比例风险回归模型。

结果

PSM后，辅助化疗组术后中位生存期为22个月，手术组为9个月；辅助化疗组1、2年累积生存率分别为78.6%、42.9%，手术组为46.4%、14.3%；辅助化疗组总体生存明显优于手术组（χ2=10.800，P<0.05）。淋巴结阳性的辅助化疗患者中位生存期为19个月，总体生存亦明显优于手术组（χ2=5.824，P<0.05）。Cox多因素分析显示，淋巴结转移和术后辅助化疗是肝门部胆管癌切除术后患者预后的独立影响因素（HR=1.903，0.343；P<0.05）。

结论

术后辅助化疗能改善肝门部胆管癌切除术后患者，尤其是淋巴结转移患者的预后。

关键词: 肝门部胆管癌, 胆道肿瘤, 化学治疗, 外科手术, 倾向性评分匹配, 预后
Objective

To evaluate the effect of postoperative adjuvant chemotherapy on clinical prognosis of patients with hilar cholangiocarcinoma after surgical resection.

Methods

Clinical data of 86 patients with hilar cholangiocarcinoma who underwent surgical resection in Sun Yat-sen Memorial Hospital of Sun Yat-sen University from January 2012 to December 2017 were retrospectively analyzed. Among them, 52 patients were male and 34 female, aged from 28 to 79 years, with a median age of 60 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to whether receiving postoperative adjuvant chemotherapy, the patients were divided into the adjuvant chemotherapy group (n=42) and operation group (n=44). After 1:1 ratio propensity score matching (PSM), the influencing factors for the survival and prognosis were analyzed. Survival analysis was conducted by Kaplan-Meier method and Log-rank test. Prognostic factors were identified by Cox proportional hazard regression model.

Results

After PSM, the median survival of patients was 22 months in the adjuvant chemotherapy group and 9 months in the operation group. In the adjuvant chemotherapy group, the 1-, 2-year cumulative survival rates were 78.6%, 42.9%, and 46.4%, 14.3% in the operation group. The overall survival in the adjuvant chemotherapy group was significantly better than that in the operation group (χ2=10.800, P<0.05). In the adjuvant chemotherapy, the median survival of patients with positive lymph node was 19 months, and the overall survival was significantly better than that in the operation group (χ2=5.824, P<0.05). Cox multivariate analysis showed that lymph node metastasis and postoperative adjuvant chemotherapy were the independent prognostic factors of patients with hilar cholangiocarcinoma after surgical resection (HR=1.903, 0.343; P<0.05).

Conclusions

Postoperative adjuvant chemotherapy can improve the clinical prognosis of patients with hilar cholangiocarcinoma after surgical resection, especially those with lymph node metastasis.

Key words: Perihilar cholangiocarcinoma, Biliary neoplasms, Chemotherapy, Surgical procedures, operative, Propensity score matching, Prognosis
表1 肝门部胆管癌切除术后患者PSM前后基线资料比较（例）
参数 PSM前 PSM后
辅助化疗组 手术组 统计值 P值 辅助化疗组 手术组 统计值 P值
性别     χ2=1.12 0.291     χ2=0.07 0.786
  男 23 29     12 11    
  女 19 15     16 17    
年龄     χ2=2.86 0.091     χ2=0.09 0.763
  <65岁 32 26     20 21    
  ≥65岁 10 18     8 7    
术前胆道引流     χ2=1.15 0.284     χ2=0.76 0.383
  是 16 12     18 21    
  否 26 32     10 7    
Bismuth分型     χ2=0.41 0.521     χ2=0.65 0.420
  Ⅰ~Ⅲ型 20 24     11 14    
  Ⅳ型 22 20     17 14    
组织学分级     Z=883 0.680     Z=392 1.000
  G1级 11 9     7 7    
  G2级 25 29     16 16    
  G3级 6 6     5 5    
T4分期     χ2=1.11 0.293     χ2<0.01 1.000
  是 7 4     3 3    
  否 35 40     25 25    
R0切除     χ2=0.41 0.521     χ2=1.17 0.280
  是 20 24     18 14    
  否 22 20     10 14    
淋巴结转移     χ2=0.07 0.790     χ2=0.08 0.783
  是 16 18     11 10    
  否 26 26     17 18    
图1 PSM后肝门部胆管癌患者术后Kaplan-Meier生存曲线
表2 肝门部胆管癌切除术后患者预后影响因素的Cox单因素及多因素分析
  例数 中位生存期（月） 单因素分析 多因素分析
HR 95%CI P值 HR 95%CI P值
组织学分级     3.516 1.383~8.937 0.029 1.530 0.962~2.433 0.072
  G1级 20 20            
  G2级 54 15            
  G3级 12 8            
淋巴结转移     1.692 1.008~2.842 0.047 1.903 1.101~3.289 0.021
  是 34 12            
  否 52 19            
术后辅助化疗     0.717 0.439~1.170 0.019 0.343 0.147~0.797 0.013
  是 42 19            
  否 44 13            
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