大导管型及小导管型肝内胆管癌的临床病理特征及预后分析

目的 分析大导管型肝内胆管癌及小导管型肝内胆管癌的临床病理特征及预后相关因素。方法 回顾性分析肝内胆管癌患者91例的临床病历资料，比较大导管型肝内胆管癌及小导管型肝内胆管癌的病理特征。采用Kaplan-Meier生存分析法做无复发生存曲线及总生存曲线分析，Log-rank法比较组间生存率。采用Cox比例回归风险模型分析大导管型肝内胆管癌患者预后的影响因素。结果 91例肝内胆管癌患者中大导管型52例，小导管型32例，未确定型7例。与小导管型比较，大导管型具有淋巴结转移、血管侵犯、血清CA199水平高、TNM分期高、肝内胆管结石病史等特点(P<0.05)。大导管型患者术后1、3、5年总生存率明显低于小导管型(P<0.05)。大导管型与小导管型术后1、3、5年无复发生存率差异无统计学意义(P>0.05)。多因素生存分析发现，淋巴结转移、TNM分期是大导管型肝内胆管癌总生存期的预后不良因素，血管侵犯、TNM分期是肿瘤无复发生存期的预后不良因素(P<0.05)。结论 大导管型及小导管型肝内胆管癌患者的临床病理特征有一定差异，大导管型预后更差，淋巴结转移、血管侵犯及TNM分...

Clinicopathological characteristics and prognosis of large-duct subtype and small-duct subtype intrahepatic cholangiocarcinoma

Objective To analyze the clinicopathological features and prognostic factors of large duct type and small duct type intrahepatic cholangiocarcinoma (ICCA).Methods The clinical data of 91 patients with ICCA were analyzed retrospectively, and the pathological features of large duct type ICCA and small duct type ICCA were compared. Kaplan-Meier survival analysis was used to analyze the recurrence-free survival (RFS) curve and overall survival (OS) curve, and Log-rank method was used to compare the survival rate between groups. Cox proportional hazard model was used to analyze the prognostic factors of patients with large duct type ICCA.Results Among the 91 patients with ICCA, there were 52 cases with large duct type, 32 cases with small duct type and 7 cases with undetermined type. Compared with the small duct type, patients with large duct type had the characteristics of lymph node metastasis, vascular invasion, high level of serum CA199, high TNM stage and history of hepatolithiasis (P＜0.05). The 1-, 3-and 5-year OS rates in patients with large duct type were significantly lower than those of small duct type (P＜0.05). There was no significant difference in 1-, 3-and 5-year RFS rates between large duct type and small duct type ICCA (P＞0.05). Multivariate survival analysis showed that lymph node metastasis and TNM stage were poor prognostic factors for OS of large duct type ICCA, while vascular invasion and TNM staging were poor prognostic factors for RFS.Conclusion There are certain differences in clinicopathological features between large duct type and small duct type ICCA. Patients with large duct type have worse prognosis than those with small duct type. In addition, lymph node metastasis, vascular invasion and TNM stage are factors affecting the OS and RFS.