影响肝胆管细胞癌手术预后的临床病理学因素分析

目的分析影响肝胆管细胞癌(ICC)患者手术预后的临床病理学因素。方法回顾性分析行根治性肝切除术的112例ICC患者的临床资料,统计患者术后1年、3年、5年累积生存率,通过单因素和多因素分析影响ICC患者预后的危险因素,并制作列线图模型。结果112例患者的中位生存期为27个月,术后1年、3年及5年的累积生存率分别为72.8%、40.7%、34.0%。单因素分析结果显示,癌胚抗原(CEA)、CA19-9、碱性磷酸酶(ALP)、HbsAg、胆管扩张、血管侵犯、局部侵犯、淋巴结转移、卫星结节、肿瘤分化程度、手术切除范围以及肿瘤TNM分期是影响ICC患者肝切除术预后的相关因素;多因素分析结果显示,HbsAg阴性、血管侵犯、卫星结节、肿瘤中低分化以及肿瘤TNM分期为ⅢA/ⅢB期是影响ICC患者预后的独立危险因素。根据多因素分析结果制作的列线图模型能较好地预测ICC患者的术后生存期。结论HbsAg阴性、血管侵犯、卫星结节、肿瘤中低分化以及肿瘤TNM分期为ⅢA/ⅢB期是影响ICC患者根治性肝切除术后生存期的独立危险因素。

Analysis of clinicopathological factors affecting the surgical prognosis of intrahepatic cholangiocarcinoma

Objective To analyze the clinicopathological factors affecting the surgical prognosis of patients with intrahepatic cholangiocarcinoma(ICC).Methods The clinical data of 112 patients with ICC underwent radical hepatectomy were retrospectively analyzed.The cumulative survival rates of patients 1 years,3 years,and 5 years after surgery were counted.The risk factors affecting the prognosis of ICC patients were analyzed by univariate and multivariate analysis,and the nomogram model was established.Results The median survival time of the 112 patients was 27 months,and the cumulative survival rates of 1 year,3 years,and 5 years after surgery were 72.8%,40.7%,and 34.0%,respectively.Univariate analysis results showed that carcinoembryonic antigen(CEA),CA19-9,alkaline phosphatase(ALP),HbsAg,cholangiectasis,vascular invasion,local invasion,lymph node metastasis,satellite nodules,degree of tumor differentiation,surgical resection range and tumor TNM stage were the related factors affecting the prognosis of ICC patients underwent hepatectomy.Multivariate analysis results showed that negative HbsAg,vascular invasion,satellite nodules,moderately and poorly differentiated tumors,and tumor TNM stage ofⅢA/ⅢB were the independent risk factors affecting the prognosis of ICC patients.The nomogram model estanlished according to the results of multivariate analysis could better predict the postoperative survival time of ICC patients.Conclusion Negative HbsAg,vascular invasion,satellite nodules,moderately and poorly differentiated tumors,and tumor TNM stage ofⅢA/ⅢB are the independent risk factors that affect the survival time of ICC patients after radical hepatectomy.