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根治性手术切除治疗早期胆管细胞癌的预后影响因素分析
Influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma after radical resection
文章发布日期:2018年09月30日  来源:  作者:黄健,蒋贝格,杨远,等  点击次数:396次  下载次数:63次

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【摘要】:目的分析手术治疗早期胆管细胞癌(ICC)患者预后的相关因素。方法收集2013年1月-2014年12月于第二军医大学第三附属医院行根治性手术切除治疗的早期ICC患者共155例,分析其临床病理特点及术后1、2、3年总体生存率及无瘤生存率。采用Cox向前逐步回归单因素及多因素分析影响早期ICC预后相关因素。 结果早期ICC多数为中年男性患者,平均直径为(5.8±2.5)cm,肝功能多无异常,伴有不同程度CA19-9水平升高,术后病理多为高中分化腺癌。患者术后1、2、3年的总体生存率分别为761%、43.9%和34.1%,无瘤生存率分别为50.3%、25.0%和18.1%。Cox多因素分析表明术前高水平CA19-9[风险比(HR)=1.705,95%可信区间(95%CI):1.096~2.652, P=0.018]、肝硬化(HR=2.399, 95%CI:1.108~5.196, P=0.026)、镜下子灶(HR=1.918, 95%CI:1.124~3.272, P=0.017)、肿瘤细胞分化程度(HR=5.568, 95%CI:2.591~11.965, P<0.000 1) 是影响早期ICC总体生存的独立危险因素;肝硬化(HR=2.142,95%CI:1.054~4.353,P=0.035)、镜下子灶(HR=2.045,95%CI:1250~3343,P=0.004)、肿瘤细胞分化程度(HR=2.748, 95%CI:1.340~5.638,P=0.006)是影响早期ICC无瘤生存的独立危险因素。结论根治性切除术为早期ICC患者首选治疗方法。术前CA19-9≥200 U/ml、肝硬化、镜下子灶、肿瘤细胞分化程度是影响早期ICC预后的独立危险因素。
【Abstract】:ObjectiveTo investigate the influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma (ICC) after surgical treatment. MethodsA total of 155 patients with early-stage ICC who underwent radical resection in The Third Affiliated Hospital of Second Military Medical University from January 2013 to December 2014 were enrolled in this study. Clinicopathological features and 1-, 2-, and 3-year overall survival rates and disease-free survival rates after surgery were analyzed. The Cox forward stepwise regression was used for the univariate and multivariate analyses of the influencing factors for the prognosis of early-stage ICC. ResultsMost patients with early-stage ICC were middle-aged men, with an average tumor diameter of 5.8±2.5 cm. Most patients had normal liver function, but there were varying degrees of increase in carbohydrate antigen 19-9 (CA19-9) level. Postoperative pathological examination revealed highly or moderately differentiated adenocarcinoma in most patients. The 1-, 2-, and 3-year overall survival rates after surgery were 76.1%, 43.9%, and 34.1%, respectively, and the 1-, 2-, and 3-year disease-free survival rates were 50.3%, 250%, and 18.1%, respectively. The Cox multivariate analysis showed that high CA19-9 level before surgery (hazard ratio [HR]=1705, 95% confidence interval [CI]: 1.096-2.652, P=0.018), liver cirrhosis (HR=2.399, 95%CI: 1.108-5.196, P=0.026), satellite nodules (HR=1.918, 95%CI: 1.124-3.272, P=0.017), and degree of tumor cell differentiation (HR=5.568, 95%CI: 2591-11.965, P<0.0001) were independent risk factors for overall survival of patients early-stage ICC. Liver cirrhosis (HR=2.142, 95%CI: 1.054-4.353, P=0.035), satellite nodules (HR=2.045, 95%CI: 1.250-3.343, P=0.004), and degree of tumor cell differentiation (HR=2.748, 95%CI: 1.340-5.638, P=0.006) were independent risk factors for disease-free survival of patients early-stage ICC. ConclusionRadical resection is the preferred treatment for patients with early-stage ICC. Preoperative CA19-9 ≥200 U/ml, liver cirrhosis, satellite nodules, and degree of tumor cell differentiation are independent risk factors for the prognosis of early-stage ICC.
【关键字】:肝肿瘤; 肝切除术; 危险因素; 预后
【Key words】:liver neoplasms; hepatectomy; risk factors; prognosis
【引证本文】:HUANG J, JIANG BG, YANG Y, et al. Influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma after surgical resection[J]. J Clin Hepatol, 2018, 34(10): 2157-2163. (in Chinese)
黄健, 蒋贝格, 杨远, 等. 根治性手术切除治疗早期胆管细胞癌的预后影响因素分析[J]. 临床肝胆病杂志, 2018, 34(10): 2157-2163.

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