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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 ›› 2022, Vol. 11 ›› Issue (06) : 619 -624. doi: 10.3877/cma.j.issn.2095-3232.2022.06.017

临床研究

肝门部胆管癌术后患者预后影响因素：单中心160例分析
房炯泽1, 杨勇1, 叶莹鹏1, 朱宏达1, 吴胜东1, 陆才德1,†()   
  1. 1. 315041　宁波大学附属李惠利医院肝胆胰外科
  • 收稿日期:2022-07-25 出版日期:2022-12-10
  • 通信作者: 陆才德
  • 基金资助:
    国家自然科学基金(82170603); 2020年浙江省医药卫生科技计划项目(2020KY865); 宁波市医疗卫生品牌学科建设项目(PPXK2018-03)

Prognostic factors of patients with perihilar cholangiocarcinoma after surgery: a single-center analysis of 160 cases

Jiongze Fang1, Yong Yang1, Yingpeng Ye1, Hongda Zhu1, Shengdong Wu1, Caide Lu1,†()   

  1. 1. Department of Hepatobiliary and Pancreatic Surgery, Lihuili Hospital Affiliated to Ningbo University, Ningbo 315041, China
  • Received:2022-07-25 Published:2022-12-10
  • Corresponding author: Caide Lu
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房炯泽, 杨勇, 叶莹鹏, 朱宏达, 吴胜东, 陆才德. 肝门部胆管癌术后患者预后影响因素：单中心160例分析[J]. 中华肝脏外科手术学电子杂志, 2022, 11(06): 619-624.

Jiongze Fang, Yong Yang, Yingpeng Ye, Hongda Zhu, Shengdong Wu, Caide Lu. Prognostic factors of patients with perihilar cholangiocarcinoma after surgery: a single-center analysis of 160 cases[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2022, 11(06): 619-624.

目的

探讨肝门部胆管癌（PHC）患者术后预后的影响因素。

方法

回顾性分析2002年1月至2019年12月在宁波大学附属李惠利医院行手术切除的160例PHC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。生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox比例风险回归模型分析患者预后影响因素。

结果

160例患者中男86例，女74例；年龄30~83岁，中位年龄63岁。Bismuth-Corlette分型Ⅰ、Ⅱ型42例，Ⅲ、Ⅳ型118例。单纯肝外胆管切除16例，肝中区域切除56例，大范围肝切除88例，其中合并血管切除重建68例，R0切除138例。PHC患者术后1、3、5年总体生存率分别为70.3%、33.5%、24.2%，1、3、5年无复发生存率分别为56.7%、36.6%、33.5%。Cox多因素分析显示，肿瘤低分化、淋巴结转移、R1切除是PHC患者术后总体生存和无复发生存的独立危险因素（HR=1.510，2.346，1.963和1.665，2.862，3.443；P<0.05）。

结论

肿瘤分化程度、淋巴结转移情况及根治切除程度与PHC患者的生存预后密切相关。

关键词: 肝门部胆管癌, 胆管肿瘤, 外科手术, 预后, 危险因素
Objective

To investigate the prognostic factors of patients with perihilar cholangiocarcinoma (PHC) after surgery.

Methods

Clinical data of 160 patients with PHC who underwent surgical resection in Lihuili Hospital Affiliated to Ningbo University from January 2002 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Survival analysis was conducted by Kaplan-Meier method and Log-rank test. The prognostic factors were analyzed by Cox proportional hazards regression model.

Results

Among 160 patients,86 patients were male and 74 female, aged from 30 to 83 years, with a median age of 63 years. 42 patients were classified as Bismuth-Corlette type Ⅰ and Ⅱ, and 118 cases were type Ⅲ and Ⅳ. 16 patients underwent simple extrahepatic bile duct resection, 56 cases of middle hepatic resection, 88 cases of extensive liver resection.68 cases underwent combined vascular resection and reconstruction and 138 cases of R0 resection, respectively. The 1-, 3- and 5-year overall survival rates of PHC patients were 70.3%, 33.5% and 24.2%, and the 1-, 3- and 5-year recurrence-free survival rates were 56.7%, 36.6% and 33.5%, respectively. Multivariate Cox analysis showed that low-grade differentiation, lymph node metastasis and R1 resection were the independent risk factors for the overall survival and recurrence-free survival of PHC patients after surgery (HR=1.510, 2.346, 1.963 and 1.665, 2.862, 3.443; P<0.05).

Conclusions

Tumor differentiation, lymph node metastasis and degree of radical resection are closely correlated with the postoperative prognosis of PHC patients.

Key words: Perihilar cholangiocarcinoma, Bile duct neoplasms, Surgical procedures, operative, Prognosis, Risk factors
图1 肝门部胆管癌患者术后总体生存和无复发生存Kaplan-Meier曲线
表1 肝门部胆管癌患者术后总体生存影响因素的Cox单因素分析
参数 例数 1年生存率（%） 3年生存率（%） 5年生存率（%） χ2值 P值
肿瘤分化程度         12.453 <0.001
  高中分化 96 78.1 44.5 31.4    
  低分化 64 58.5 15.9 12.7    
淋巴结转移         20.469 <0.001
  是 65 56.8 18.4 4.6    
  否 95 79.1 43.1 35.7    
切除类型         4.071 0.044
  R0切除 138 69.4 42.8 27.9    
  R1切除 22 75.4 5.0 5.0    
表2 肝门部胆管癌患者术后无复发生存影响因素的Cox单因素分析
参数 例数 1年生存率（%） 3年生存率（%） 5年生存率（%） χ2值 P值
肿瘤分化程度         9.194 0.002
  高中分化 96 66.5 45.1 45.1    
  低分化 64 42.7 25.0 16.7    
淋巴结转移         16.698 <0.001
  是 65 36.4 16.9 0    
  否 95 69.8 49.0 49.0    
切除类型         10.279 0.001
  R0切除 138 58.9 4.08 40.8    
  R1切除 22 40.0 13.3 13.3    
表3 肝门部胆管癌患者术后总体生存影响因素的Cox多因素分析
因素 b SE(b) Wald χ2 HR 95%CI P值
肿瘤低分化 0.412 0.142 8.464 1.510 1.144~1.994 0.004
淋巴结转移 0.853 0.209 16.618 2.346 1.557~3.536 <0.001
R1切除 0.675 0.264 6.553 1.963 1.171~3.290 0.010
表4 肝门部胆管癌患者术后无复发生存影响因素的Cox多因素分析
因素 b SE(b) Wald χ2 HR 95%CI P值
肿瘤低分化 0.510 0.196 6.786 1.665 1.135~2.444 0.009
淋巴结转移 1.052 0.265 15.692 2.862 1.701~4.815 <0.001
R1切除 1.236 0.325 14.495 3.443 1.822~6.507 <0.001
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