探讨远端胆管癌（DCCA）术后生存预后及其影响因素。

回顾性分析2011年1月至2019年12月解放军总医院肝胆外科收治的116例行胰十二指肠切除术的DCCA患者临床病理资料。患者均签署知情同意书，符合医学伦理学规定。其中男71例，女45例；年龄31~82岁，中位年龄65岁。随访其生存预后情况。生存分析采用Kaplan-Meier法和Log-rank检验，生存预后影响因素分析采用Cox多因素回归分析。

DCCA患者术后1、3、5年总体生存率分别为75.2%、41.9%、31.5%。Cox多因素分析显示，表皮生长因子受体（EGFR）表达水平（RR=1.600，95%CI：1.086~2.357）、淋巴结转移比率（MLNR） （RR=2.899，95%CI：1.365~6.158）和肿瘤分化程度（RR=2.009，95%CI：1.245~3.243）是影响DCCA术后远期生存的独立危险因素。MLNR=0患者1、3、5年生存率分别为83.0%、50.7%和42.5%，0<MLNR≤0.17患者相应为80.5%、37.4%和37.4%，而MLNR>0.17患者为48.2%、0和0，MLNR值越高患者预后越差（χ²=26.834，P=0.006）。EGFR阴性患者1、3、5年生存率分别为80.3%、50.3%和41.2%，弱阳性患者相应为81.3%、16.2%和16.2%，中度和强阳性患者为27.8%、0和0，EGFR表达越强，患者总体生存越差（χ²=20.848，P=0.017）。肿瘤高分化患者1、3、5年生存率分别为92.9%、68.8%和68.8%，中分化患者相应为83.8%、40.3%和32.3%，低分化患者为50.8%、19.8%和19.8%，分化程度越低患者预后越差（χ²=32.493，P=0.004）。

胰十二指肠切除术仍是DCCA患者最佳治疗方式，MLNR、EGFR表达水平和肿瘤分化程度是影响DCCA患者术后生存的独立危险因素。MLNR越高预后越差，EGFR表达水平越高预后越差，肿瘤分化程度越低患者预后也越差。

To investigate the survival and prognosis of distal cholangiocarcinoma (DCCA) and its prognostic factors.

Clinicopathological data of 116 DCCA patients who underwent pancreaticoduodenectomy from January 2011 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 71 patients were male and 45 female, aged from 31 to 82 years, with a median age of 65 years. The survival and prognosis were followed up. Survival analysis was performed by Kaplan-Meier method and Log-rank test. The influencing factors of survival and prognosis were analyzed by multivariate Cox’s regression analysis.

The 1-, 3- and 5-year overall survival rates of patients with DCCA after operation were 75.2%, 41.9% and 31.5%, respectively. Multivariate Cox’s regression analysis showed that the expression level of epidermal growth factor receptor (EGFR) (RR=1.600, 95%CI: 1.086-2.357), metastatic lymph node ratio (MLNR) (RR=2.899, 95%CI: 1.365-6.158) and degree of tumor differentiation (RR=2.009, 95%CI: 1.245-3.243) were the independent risk factors for long-term survival of DCCA patients after operation. The 1-,3- and 5-year survival rates of patients with MLNR=0 were 83.0%, 50.7% and 42.5%, and 80.5%, 37.4% and 37.4% for those with 0<MLNR≤0.17, and 48.2%, 0 and 0 for those with MLNR>0.17, respectively. The higher the MLNR, the worse the prognosis (χ²=26.834, P=0.006). The 1-, 3- and 5-year survival rates of EGFR-negative patients were 80.3%, 50.3% and 41.2%, and 81.3%, 16.2% and 16.2% for those with weak expression of positive EGFR, and 27.8%, 0 and 0 for those with moderate and high expression of positive EGFR, respectively. The higher the EGFR expression, the worse the overall survival (χ²=20.848, P=0.017). The 1-, 3- and 5-year survival rates of highly-differentiated DCCA patients were 92.9%, 68.8% and 68.8%, and 83.8%, 40.3% and 32.3% for those with moderately-differentiated DCCA, and 50.8%, 19.8% and 19.8% for those with poorly-differentiated DCCA, respectively. The lower the degree of tumor differentiation, the worse the prognosis (χ²=32.493, P=0.004).

Pancreaticoduodenectomy remains the optimal treatment for patients with DCCA. The expression levels of MLNR, EGFR and the degree of tumor differentiation are the independent risk factors of postoperative survival of DCCA patients. The higher the MLNR, the worse the prognosis. The higher the EGFR expression level, the worse the prognosis. The lower the degree of tumor differentiation, the worse the prognosis.