两种不同类型肝门周围胆管癌临床病理特征及生存预后

doi:10.3877/cma.j.issn.2095-3232.2025.06.018

中华肝脏外科手术学电子杂志 ›› 2025, Vol. 14 ›› Issue (06) : 931 -938. doi: 10.3877/cma.j.issn.2095-3232.2025.06.018

临床研究

两种不同类型肝门周围胆管癌临床病理特征及生存预后

杨刚¹, 黄徐建², 朱建交², 熊永福¹, 李敬东^†^,²(

)

¹　637000　四川省　南充市，川北医学院附属医院文化路院区普外科　川北医学院肝胆胰肠疾病研究所　四川省消化系统疾病临床医学研究中心
²　637000　四川省　南充市，川北医学院附属医院文化路院区肝胆外科　川北医学院肝胆胰肠疾病研究所　四川省消化系统疾病临床医学研究中心

收稿日期:2025-05-05 出版日期:2025-12-10
通信作者: 李敬东
基金资助:
四川省卫健委2023年临床专项(23LCYJ033); 中国博士后科研启动基金(2023MD734153)

Clinicopathological features, survival and prognosis of two different types of perihilar cholangiocarcinoma

Gang Yang¹, Xujian Huang², Jianjiao Zhu², Yongfu Xiong¹, Jingdong Li²^,^†()

¹ Department of General Surgery, Affiliated Hospital of North Sichuan Medical College, Institute of Hepatobiliary Pancreatic Intestinal Diseases of North Sichuan Medical College, Clinical Research Center for Digestive Diseases of Sichuan Province, Nanchong 637000, China
² Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Institute of Hepatobiliary Pancreatic Intestinal Diseases of North Sichuan Medical College, Clinical Research Center for Digestive Diseases of Sichuan Province, Nanchong 637000, China

Received:2025-05-05 Published:2025-12-10
Corresponding author: Jingdong Li

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引用本文：

杨刚, 黄徐建, 朱建交, 熊永福, 李敬东. 两种不同类型肝门周围胆管癌临床病理特征及生存预后[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(06): 931-938.

Gang Yang, Xujian Huang, Jianjiao Zhu, Yongfu Xiong, Jingdong Li. Clinicopathological features, survival and prognosis of two different types of perihilar cholangiocarcinoma[J/OL]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2025, 14(06): 931-938.

目的

探讨肝门部胆管癌（hCCA）与累及肝门的肝内胆管癌（hICC）患者临床病理特征及生存预后，为实际诊疗过程中的鉴别诊断与手术决策提供依据。

方法

回顾性分析2015年1月至2021年12月川北医学院附属医院收治的158例胆管癌患者临床资料。患者或家属均签署知情同意书，符合医学伦理学规定。其中男58例，女100例；年龄32~85岁，中位年龄62岁。90例hICC，68例hCCA。收集患者基本信息、实验室检测、手术记录、病理检查报告等可能对患者预后产生影响的临床指标。术后门诊随访，记录患者生存时间。患者临床病理特征比较采用t检验、Wilcoxon秩和检验、χ²检验或Fisher确切概率法。生存分析采用Kaplan-Meier法和Log-rank检验。

结果

与hCCA相比，hICC患者CA19-9水平更高（Z=2.712，P<0.05）、肿瘤直径更大（Z=-2.457，P<0.05），卫星灶发生率更高（χ²=4.621，P<0.05）、AJCC T分期更晚（χ²=10.109，P<0.05）；而hCCA患者TB水平更高（Z=2.549，P<0.05），术前行胆道引流的比例更大（χ²=4.594，P<0.05）。与hCCA相比，hICC患者更倾向于选择扩大肝切除，包括左右半肝或左右三肝切除（χ²= 10.681，P<0.05）；hICC患者有更高的门静脉切除率（χ²=5.274，P<0.05）。患者随访时间0.2~57.4个月，中位随访时间为18个月，随访期间43例hICC、15例hCCA患者死亡。hICC和hCCA患者中位总体生存期分别为 23.8、44.9个月，差异有统计学意义（χ²=8.324，P=0.004）。

结论

与hCCA相比，hICC表现出更晚的临床病理特征、更具侵袭性的生物学行为和更差的预后。严格区分hICC和hCCA对于制定治疗方案并预测hICC和hCCA患者的预后具有临床意义。

关键词: 肝门部胆管癌, 肝内胆管癌, 肝门周围胆管癌, 病理特征, 生存预后

Objective

To investigate the clinicopathological features, survival and prognosis of patients with hilar cholangiocarcinoma (hCCA) and hilar-type intrahepatic cholangiocarcinoma (hICC), aiming to provide references for differential diagnosis and surgical plan in clinical diagnosis and treatment.

Methods

Clinical data of 158 patients with cholangiocarcinoma admitted to the Affiliated Hospital of North Sichuan Medical College from January 2015 to December 2021 were retrospectively analyzed. The informed consents of all patients or their families were obtained and the local ethical committee approval was received. Among them, 58 patients were male and 100 female, aged from 32 to 85 years, with a median age of 62 years, 90 cases of hICC and 68 hCCA. Baseline data, laboratory examination, surgical records, pathological examination reports and other potential prognostic factors were collected. Postoperative outpatient follow-up was conducted to record the survival time of patients. Clinicopathological features of all patients were compared by t-test, Wilcoxon rank-sum test, Chi-square test or Fisher's exact test. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

Compared with hCCA, CA19-9 level was higher (Z=2.712, P<0.05), tumor diameter was larger (Z=-2.457, P<0.05), the incidence of satellite lesions was higher (χ²=4.621, P<0.05) and AJCC T staging was later in hICC patients (χ²=10.109, P<0.05). However, the level of bilirubin was higher (Z=2.549, P<0.05), and the proportion of preoperative biliary drainage was higher in hCCA patients (χ²=4.594, P<0.05). Compared with hCCA, hICC patients were more inclined to adopting extended hepatectomy, including left and right hepatectomy or left and right trihepatectomy (χ²=10.681, P<0.05). The portal vein resection rate was higher in hICC patients (χ²=5.274, P<0.05). The patients were followed up for 0.2-57.4 months, with a median follow-up time of 18 months. During postoperative follow-up, 43 hICC patients and 15 hCCA patients died. The median overall survival (OS) of patients with hICC and hCCA was 23.8 and 44.9 months, and the difference was statistically significant (χ²=8.324, P=0.004).

Conclusions

Compared with hCCA, hICC patients have advanced clinicopathological features, more aggressive biological behavior and worse prognosis. It is of clinical significance to differentially diagnose hICC from hCCA, determine treatment regimens and predict clinical prognosis of hICC and hCCA patients.

Key words: Hilar cholangiocarcinoma, Intrahepatic cholangiocarcinoma, Perihilar cholangiocarcinoma, Pathological features, Survival prognosis

表1 hICC与hCCA患者临床病理特征比较

变量	hICC 组	hCCA 组	统计值	P值
年龄(岁, $x ¯$ ±s)	62±11	63±10	t=-0.661	0.517
性别(例, 男/女)	30/60	28/40	χ²=0.715	0.398
BMI(kg/m², $x ¯$ ±s)	22.3±2.7	22.2±2.8	t=0.263	0.791
CA19-9[kU/L, M(Q₁, Q₃)]	195 (74,552)	128 (49,369)	Z=2.712	0.022
CEA [μg/L, M(Q₁, Q₃)]	2.7(1.7, 4.1)	2.9(1.7, 3.7)	Z=3.089	0.917
ALB (g/L, $x ¯$ ±s)	41±4	37±6	t=1.127	0.262
TB [μmol/L, M(Q₁, Q₃)]	117(427, 191)	166(70, 269)	Z=2.549	0.045
术前胆道引流[例(%)]	43(48)	45(66)	χ²=4.594	0.003
肿瘤直径 [cm, M(Q₁, Q₃)]	4.6 (2.7, 7.0)	1.5 (0.8, 2.6)	Z=-2.457	0.014
门静脉侵犯[例(%)]	35(39)	17(25)	χ²=2.784	0.095
肝动脉侵犯[例(%)]	17 (19)	11 (16)	χ²=0.053	0.817
神经侵犯[例(%)]	52 (58)	45 (66)	χ²=0.825	0.364
卫星灶[例(%)]	15(17)	3(4)	χ²=4.621	0.032
淋巴转移[例(%)]	35(39)	30(44)	χ²=0.248	0.618
AJCC T分期(例, T1~T2/ T3~T4)	23/67	35/33	χ²=10.109	0.001
AJCC N分期(例, N0/N1~N2/Nx)	36/41/13	38/20/10	χ²=4.722	0.094
分化程度(例, 高/中/低)	39/36/15	36/22/10	χ²=1.464	0.481
肿瘤切缘(例, R0/R1)	72/18	58/10	χ²=0.425	0.514

表1 hICC与hCCA患者临床病理特征比较

变量	hICC 组	hCCA 组	统计值	P值
年龄(岁, $x ¯$ ±s)	62±11	63±10	t=-0.661	0.517
性别(例, 男/女)	30/60	28/40	χ²=0.715	0.398
BMI(kg/m², $x ¯$ ±s)	22.3±2.7	22.2±2.8	t=0.263	0.791
CA19-9[kU/L, M(Q₁, Q₃)]	195 (74,552)	128 (49,369)	Z=2.712	0.022
CEA [μg/L, M(Q₁, Q₃)]	2.7(1.7, 4.1)	2.9(1.7, 3.7)	Z=3.089	0.917
ALB (g/L, $x ¯$ ±s)	41±4	37±6	t=1.127	0.262
TB [μmol/L, M(Q₁, Q₃)]	117(427, 191)	166(70, 269)	Z=2.549	0.045
术前胆道引流[例(%)]	43(48)	45(66)	χ²=4.594	0.003
肿瘤直径 [cm, M(Q₁, Q₃)]	4.6 (2.7, 7.0)	1.5 (0.8, 2.6)	Z=-2.457	0.014
门静脉侵犯[例(%)]	35(39)	17(25)	χ²=2.784	0.095
肝动脉侵犯[例(%)]	17 (19)	11 (16)	χ²=0.053	0.817
神经侵犯[例(%)]	52 (58)	45 (66)	χ²=0.825	0.364
卫星灶[例(%)]	15(17)	3(4)	χ²=4.621	0.032
淋巴转移[例(%)]	35(39)	30(44)	χ²=0.248	0.618
AJCC T分期(例, T1~T2/ T3~T4)	23/67	35/33	χ²=10.109	0.001
AJCC N分期(例, N0/N1~N2/Nx)	36/41/13	38/20/10	χ²=4.722	0.094
分化程度(例, 高/中/低)	39/36/15	36/22/10	χ²=1.464	0.481
肿瘤切缘(例, R0/R1)	72/18	58/10	χ²=0.425	0.514

表2 hICC与hCCA患者术中及术后情况比较

变量	hICC 组	hCCA 组	统计值	P值
肝切除方式[例(%)]			χ²=10.681	0.013
左半肝切除	42(47)	39(57)
右半肝切除	23(26)	23(34)
左三肝切除	10(11)	4(6)
右三肝切除	15(17)	2(3)
肝胰十二指肠切除[例(%)]	3(3)	2(3)	χ²=0.019	0.946
尾状叶切除[例(%)]	67(74)	57(84)	χ²=2.017	0.186
门静脉切除[例(%)]	29(32)	11(16)	χ²=5.274	0.024
肝动脉切除[例(%)]	13(14)	6(9)	χ²=0.529	0.628
手术时间 (min, $x ¯$ ±s)	430±134	377±129	t=2.536	0.012
术中出血量[ml, M(Q₁, Q₃)]	275(150, 600)	200(100, 525)	Z=3.431	0.189
输血情况[例(%)]	32 (36)	22 (32)	χ²=0.176	0.748
术后并发症[例(%)]	39 (43)	21 (31)	χ²=2.549	0.141
手术死亡[例(%)]	4 (4)	2(3)	χ²=0.239	0.724
住院时间[d, M(Q₁, Q₃)]	17 (10, 28)	9 (6, 17)	Z=-2.652	0.004

表2 hICC与hCCA患者术中及术后情况比较

变量	hICC 组	hCCA 组	统计值	P值
肝切除方式[例(%)]			χ²=10.681	0.013
左半肝切除	42(47)	39(57)
右半肝切除	23(26)	23(34)
左三肝切除	10(11)	4(6)
右三肝切除	15(17)	2(3)
肝胰十二指肠切除[例(%)]	3(3)	2(3)	χ²=0.019	0.946
尾状叶切除[例(%)]	67(74)	57(84)	χ²=2.017	0.186
门静脉切除[例(%)]	29(32)	11(16)	χ²=5.274	0.024
肝动脉切除[例(%)]	13(14)	6(9)	χ²=0.529	0.628
手术时间 (min, $x ¯$ ±s)	430±134	377±129	t=2.536	0.012
术中出血量[ml, M(Q₁, Q₃)]	275(150, 600)	200(100, 525)	Z=3.431	0.189
输血情况[例(%)]	32 (36)	22 (32)	χ²=0.176	0.748
术后并发症[例(%)]	39 (43)	21 (31)	χ²=2.549	0.141
手术死亡[例(%)]	4 (4)	2(3)	χ²=0.239	0.724
住院时间[d, M(Q₁, Q₃)]	17 (10, 28)	9 (6, 17)	Z=-2.652	0.004

图1 hICC与hCCA患者及不同手术方式患者的Kaplan-Meier生存曲线注：hICC为累及肝门的肝内胆管癌，hCCA为肝门部胆管癌

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Clinicopathological features, survival and prognosis of two different types of perihilar cholangiocarcinoma

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Clinicopathological features, survival and prognosis of two different types of perihilar cholangiocarcinoma