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

黄健; 蒋贝格; 杨远; 顾方明; 袁声贤; 潘泽亚

doi:10.3969/j.issn.1001-5256.2018.10.019

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

DOI: 10.3969/j.issn.1001-5256.2018.10.019

第二军医大学第三附属医院肝外三科

基金项目:

国家自然科学基金面上项目(81672721)；

详细信息

中图分类号: R735.8
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出版历程
- 出版日期: 2018-10-20

Influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma after radical resection

Third Department of Hepatic Surgery, The Third Affiliated Hospital of Second Military Medical University

Research funding:

摘要

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. 0962. 652,P=0. 018]、肝硬化（HR=2. 399,95%CI:1. 1085. 196,P=0. 026）、镜下子灶（HR=1. 918,95%CI:1. 1243. 272,P=0. 017）、肿瘤细胞分化程度（H...
- 肝肿瘤 /
- 肝切除术 /
- 危险因素 /
- 预后
Abstract: Objective To investigate the influencing factors for the prognosis of patients with early-stage intrahepatic cholangiocarcinoma ( ICC) after surgical treatment. Methods A 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. Results Most 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. Conclusion Radical 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.
- liver neoplasms /
- hepatectomy /
- risk factors /
- prognosis

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参考文献(25)

[1]RAZUMILAVA N, GORES GJ.Cholangiocarcinoma[J].Lancet, 2014, 383 (9935) :2168-2179.

[2]SU LH, ZHU XU, ZHANG LY.Diagnosis strategies for intrahepatic cholangiocarcinoma[J].J Clin Hepatol, 2017, 33 (1) :180-183. (in Chinese) 粟立红, 朱新宇, 张缭云.肝内胆管癌的诊断策略[J].临床肝胆病杂志, 2017, 33 (1) :180-183.

[3]LEI Z, XIA Y, SI A, et al.Antiviral therapy improves survival in patients with HBV infection and intrahepatic cholangiocarcinoma undergoing liver resection[J].J Hepatol, 2017.[Epub ahead of print]

[4] WEI MY, ZHANG YY, GENG ZM, et al.Clinicopathological features and lymph node metastases characteristics of intrahepatic eholangiocarcinoma:A muhicenter retrospective study (A reporof 1321cases) [J].Chin J Dig Surg, 2018, 17 (3) :257-265. (in Chinese) 魏妙艳, 张园园, 耿智敏, 等.肝内胆管癌临床病理特征及淋巴结转移特点的多中心回顾性研究 (附1321例报告) [J].中华消化外科杂志, 2018, 17 (3) :257-265.

[5]WU XS, LIU YB.Progress on strategy of surgical treatment for intrahepatic cholangiocarcinoma[J].Chin J Dig Surg, 2016, 15 (11) :1131-1134. (in Chinese) 吴向嵩, 刘颖斌.肝内胆管细胞癌手术治疗策略的进展[J].中华消化外科杂志, 2016, 15 (11) :1131-1134.

[6]TAN JC, COBURN NG, BAXTER NN, et al.Surgical management of intrahepatic cholangiocarcinoma-a population-based study[J].Ann Surg Oncol, 2008, 15 (2) :600-608.

[7]BRIDGEWATER J, GALLE PR, KHAN SA, et al.Guidelines for the diagnosis and management of intrahepatic cholangiocarcinoma[J].J Hepatol, 2014, 60 (6) :1268-1289.

[8]KHAN SA, TOLEDANO MB, TAYLOR-ROBINSON SD.Epidemiology, risk factors, and pathogenesis of cholangiocarcinoma[J].HPB (Oxford) , 2008, 10 (2) :77-82.

[9]SHAIB YH, DACILA JA, MCGLYN K, et al.Rising incidence of intrahepatic cholangiocarcinoma in the United States:A true increase?[J].J Hepatol, 2004, 40 (3) :472-477.

[10]PATEL T.Worldwide trends in mortality from biliary tract malignancies[J].BMC Cancer, 2002, 2:10.

[11]ENDO I, GONEN M, YOPP AC, et al.Intrahepatic cholangiocarcinoma:Rising frequency, improved survival, and determinants of outcome after resection[J].Ann Surg, 2008, 248 (1) :84-96.

[12]NATHAN H, ALOIA TA, VAUTHEY JN, et al.A proposed staging system for intrahepatic cholangiocarcinoma[J].Ann Surg Oncol, 2009, 16 (1) :14-22.

[13]SONBARE DJ.Influence of surgical margins on outcome in patients with intrahepatic cholangiocarcinoma:A multicenter study by the AFC-IHCC-2009 Study Group[J].Ann Surg, 2014, 259 (2) :e36.

[14]ZHOU SJ, HUANG ZY.Prognostic factors for tumor recurrence and metastasis of intrahepatic cholangiocarcinoma after radical resection[J].Chin J Gen Surg, 2014, 23 (8) :1024-1029. (in Chinese) 周少君, 黄志勇.肝内胆管癌根治性切除术后肿瘤复发转移的预后因素分析[J].中国普通外科杂志, 2014, 23 (8) :1024-1029.

[15]LEE TY, LEE SS, JUNG SW, et al.Hepatitis B virus infection and intrahepatic cholangiocarcinoma in Korea:A case-control study[J].Am J Gastroenterol, 2008, 103 (7) :1716-1720.

[16]ZHOU YM, YIN ZF, YANG JM, et al.Risk factors for intrahepatic cholangiocarcinoma:A case-control study in China[J].World JGastroenterol, 2008, 14 (4) :632-635.

[17]SEKIYA S, SUZUKI A.Intrahepatic cholangiocarcinoma can arise from Notch-mediated conversion of hepatocytes[J].J Clin Invest, 2012, 122 (11) :3914-3918.

[18]SHAIB YH, EI-SERAG HB, DAVILA JA, et al.Risk factors of intrahepatic cholangiocarcinoma in the United States:A case-control study[J].Gastroenterology, 2005, 128 (3) :620-626.

[19]SORENSEN HT, FRIIS S, OLSEN JH, et al.Risk of liver and other types of cancer in patients with cirrhosis:A nationwide cohort study in Denmark[J].Hepatology, 1998, 28 (4) :921-925.

[20]PALMER WC, PATEL T.Are common factors involved in the pathogenesis of primary liver cancers?A meta-analysis of risk factors for intrahepatic cholangiocarcinoma[J].J Hepatol, 2012, 57 (1) :69-76.

[21]GUO LH, XU HX.Contrast-enhanced ultrasound in the diagnosis of hepatocellular carcinoma and intrahepatic cholangiocarcinoma:controversy over the ASSLD guideline[J].Biomed Res Int, 2015, 2015:349172.

[22]LIANG JJ, LI HC, LI XL, et al.The diagnosis value of CA19-9in different disease and tumor[J].Chin J Clin Ration Drug Use, 2010, 3 (9) :30-31. (in Chinese) 梁晶晶, 李红春, 李先莉, 等.CA19-9在不同病种和肿瘤中的诊断价值[J].临床合理用药杂志, 2010, 3 (9) :30-31.

[23]TAMANDL D, HERBERGER B, GRUENBERGER B, et al.Influence of hepatic resection margin on recurrence and survival in intrahepatic cholangiocarcinoma[J].Ann Surg Oncol, 2008, 15 (10) :2787-2794.

[24]CHEN JJ, LI WG.An excerpt of (2016) cholangiocarcinoma:Current knowledge and future perspectives consensus statement from the European Network for the Study of Cholangiocarcinoma (ENS-CCA) [J].J Clin Hepatol, 2016, 32 (10) :1847-1850. (in Chinese) 陈嘉佳, 李文岗.《2016年欧洲胆管癌研究网络共识:胆管细胞癌研究现状及前景展望》摘译[J].临床肝胆病杂志, 2016, 32 (10) :1847-1850.

[25]JI LH, ZHAO G, WU ZY.Typing and staging and treatment of intrahepatic cholangiocarcinoma[J].Chin J Dig Surg, 2010, 9 (3) :193-196. (in Chinese) 季林华, 赵刚, 吴志勇.肝内胆管癌分型分期与治疗[J].中华消化外科杂志, 2010, 9 (3) :193-196.

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