肝内胆管细胞癌预后及其影响因素分析

目的 探讨肝内胆管细胞癌（ICC）的预后及其影响因素。 方法 回顾性分析2002年8月至2012年12月中山大学附属第三医院收治的77例ICC病人的临床资料,采用Kaplan-Meier法绘制生存曲线和计算累积存活率,Log-rank检验及Cox回归模型评估影响预后的因素。 结果 77例病人1、3、5年存活率分别为44.4%、27.6%、23.6%,中位生存期为10个月。45例行根治性R0手术病人的1年、3年、5年存活率分别为69.4%、50.0%和42.5%,中位生存期为25个月。单因素分析表明,乙肝、肿瘤数目、血管侵犯、远处转移、TNM分期、手术方式和病理分化程度与预后密切相关（P＜0.05）,多因素分析显示手术方式（χ2=36.091,P＜0.001）和肿瘤数目（χ2=9.496,P=0.002）是影响预后的独立因素。结论 手术方式和肿瘤数目是影响ICC病人预后的独立危险因素;根治性R0切除能明显改善预后,提高肝内胆管细胞癌病人存活率。     

肝内胆管细胞癌预后因素分析

目的研究影响肝内胆管细胞癌（ICC）手术预后的因素，探讨提高ICC疗效的途径。方法回顾分析1996年12月至2003年6月在我院手术治疗的183例ICC病人的临床资料，对成功随访到的132例病人用Cox回归模型，选择15个对预后可能产生影响的因素进行统计学分析。结果132例外科手术治疗病人1，3，5年生存率分别为51．3％、21．6％和11．8％，统计分析结果显示病人的预后与手术方式、病理分型、是否淋巴结转移以及术前血清CA19—9水平显著相关，而与是否输血、放疗、化疗、肿瘤大小、肝硬化、AFP、TBIL、A／G（白球蛋白比）、性别、年龄等无明显相关。结论规则性肝叶切除＋淋巴结清扫手术是ICC主要的治疗措施；对于术后肝内复发和淋巴结转移的积极预防和治疗是提高ICC生存率的主要策略。     

肝内胆管细胞癌的外科治疗及预后因素分析

目的探讨肝内胆管细胞癌（ICC）患者的外科治疗方法和影响手术预后的因素。方法回顾性分析80例经手术治疗的ICC患者的临床病理资料,对其中71例肿瘤切除的患者行术后生存预后的单因素和多因素分析。结果本组80例手术患者术后中位生存时间为21．5月。1、3、5年生存率为68．6％、40-3％、25．4％。根治性手术切除组和姑息性手术切除组的中位生存时间分别为40个月及15个月,两组间比较差异有统计学意义（X^2=13．62,P〈0．001）。本组总的肿瘤切除率为88．8％（71／80）,对可能影响患者肿瘤切除术后生存的15个因素分别进行单因素分析,结果表明肿瘤大小、肿瘤数目、淋巴结转移、术前血清CAl9-9水平、手术切缘及邻近组织器官侵犯对预后有影响（P〈0．05）。COX模型多因素分析结果表明手术切缘和肿瘤数目是两个独立预后因素。结论手术切除是ICC的首选治疗方法,R0切除和单个肿瘤是评估ICC患者肿瘤切除术后取得良好预后的独立指标。     

肝内胆管细胞癌发病机制研究进展

肝内胆管细胞癌（Intrahepatic Cholangiocarcinoma;ICC）是一类来源于肝内小胆管（包括二级胆管）上皮细胞的恶性肿瘤[1],是仅次于肝细胞癌（Hepatocellular Carcinoma;HCC）的另一种常见的原发性肝癌,约占所有原发性肝癌的5％～ 30％[2].近年来的全球研究数据表明,ICC的发病率呈逐年上升的趋势[3,4].目前对此病发病机制的研究还不深入,已有的研究发现,ICC发病可能与以下危险因素有关,如原发性硬化性胆管炎（Primary Sclerosing Cholangitis,PSC）、纤维性多囊性肝病、肝内胆管结石、寄生虫感染、肝炎病毒感染、化学致癌物的接触、糖尿病、肥胖、吸烟等[5-13].本文将对ICC的发病机制及其与主要危险因素之间的关系做一综述.     

37例肝内胆管细胞癌手术治疗分析

目的 提高肝内胆管细胞癌的诊断和治疗水平,分析其临床特点及预后相关因素.方法 回顾性分析1970～2005年外科治疗的37例肝内胆管细胞癌患者的临床资料.结果 37例患者中AFP阳性率10.8%(4/37),肝硬化阳性率24.3%(937).根治性切除组1、3、5年生存率82.3%、45.8%、45.8%;非根治性切除组1、3年生存率11.1%、0%.结论 肝内胆管细胞癌以手术治疗为主.根治性手术切除是获得长期生存的唯一途径.     

肝内胆管细胞癌根治性切除术后临床预后影响因素的研究

目的探讨肝内胆管细胞癌（ICC）行根治性切除（R0切除）术后的独立预后影响因素。 方法回顾性分析中山大学附属第一医院自2002年1月至2018年8月行R0切除并经病理确诊的237例ICC患者的临床病理及随访资料,采用Kaplan-Meier法构建生存曲线;单因素及多因素COX回归分析筛选影响患者生存预后的独立因素。一致性指数（C-index）、时间依赖性受试者工作特征曲线（ROC曲线）、曲线下面积（AUC）及校准曲线用于评价COX回归模型的预测效能。 结果237例ICC患者的中位生存期为19.93个月（95%CI=14.31~26.21）,术后1、2、3年生存率分别为62.3%、45.0%及35.6%。单因素及多因素回归分析显示谷氨酰转移酶（GGT） >53 U/L（P=0.001）、CA125>17.4 U/ml（P<0.001）、淋巴结转移（P=0.039）、肿瘤分化不良（P<0.001）是ICC患者行R0切除术后预后不良的独立危险因素。按照删除概率P>0.1的标准,纳入癌胚抗原（CEA）（P=0.092）后的预后模型C-index为0.74（95%CI=0.68~0.78）,不同随访时间点对应的AUC值均在0.8左右,模型具有良好的预测效能。 结论GGT、CEA、CA125、淋巴结转移情况及肿瘤分化程度可作为ICC患者R0切除术后临床预后的预测指标。     

肝内胆管细胞癌的外科治疗进展

肝内胆管细胞癌(ICC)具有显著的局部播散和淋巴道转移的特性.治愈ICC的惟一选择是根治性手术,应行规则性肝切除或扩大肝切除;是否常规清扫淋巴结以及淋巴结清扫的范围目前研究较多,结论有待进一步证实.姑息性切除仍然可以改善部分病人的预后.再次手术对于术后"超过一年"的部分肝内复发病人也有较好的疗效.肝移植仅适用于高度选择的早期病人或者谨慎的临床试验,并建议联合术后放化疗等以改善预后.     

肝内胆管细胞癌的临床病理和预后分析

肝内胆管细胞癌（ICC）的是一种起源于肝内胆管上皮细胞的罕见的肝脏恶性肿瘤,起源于二级胆管及起远端的恶性肿瘤,确诊时往往已处于进展期,常伴肿瘤细胞临近组织浸润,如门静脉,肝动脉或邻近肝组织。     

肝内胆管结石合并肝内胆管细胞癌的外科诊治

肝内胆管结石(Hepatolithiasis,HL),又称原发性肝胆管结石或肝胆管结石病,是指存在于左右肝管汇合部以上的结石,其确切病因尚不明确,多见于远东和东南亚国家,发病率约为2％～25％,而西方国家较为少见,仅为0.6％～1.3％[1-4].长期的HL会导致反复的肝内胆管炎症,继发肝内胆管狭窄,导致肝实质萎缩、胆...     

末梢型肝内胆管细胞癌的诊治分析

目的探讨末梢型肝内胆管细胞癌的诊断和治疗方法，评价淋巴清扫在末梢型肝内胆管细胞癌手术中的意义。方法回顾性分析我院1993年1月至2003年4月手术治疗28例末梢型肝内胆管细胞癌的临床资料，对发病特点，症状体征，影像学检查，病理特点和手术治疗效果进行分析。结果单因素生存分析显示手术切除组1，3，5年生存率分别为78．9％，36．8％，21．1％，未切除组15．8％，0，0，两组有显著性差异（P〈0．001）。进行淋巴结清扫组1，3，5年生存率分别为100％，60％，40％，未进行淋巴结清扫切除组为55．5％，11．1％，0，两组有显著性差异（P〈0．001）。合并门静脉癌栓组1，3，5年生存率分别为50％，0，0，未合并门静脉癌栓组为86．7％，46．7％，26．7％，两组有显著性差异（P=0．004）。而COX比例风险回归模型多因素分析显示手术切除和淋巴清扫与预后显著相关，而门静脉癌栓与生存没有显著相关性。结论淋巴转移，手术切除是影响生存的主要因素，手术切除能改善预后，术中进行肝门淋巴脂肪清扫能提高术后生存率。     

Long-term survival and prognostic factors in the surgical treatment for intrahepatic cholangiocarcinoma

Background/Purpose. We retrospectively investigated the clinicopathologic features and outcome of 51 patients who underwent hepatectomy for intrahepatic cholangiocellular carcinoma (ICC) between 1991 and 2000, and we also analyzed the potential prognostic factors for long-term survival. Methods. There were 27 men and 24 women, with a mean age of 63.7 years. The surgical procedures were extended right or left hepatectomy (15 cases), right or left hepatectomy (19 cases), bisegmentectomy (3 cases), segmentectomy (7 cases), and subsegmentectomy (7 cases). The macroscopic findings of the excised tumor showed the mass-forming (MF) type (31 cases), the periductal-infiltrating (PI) type (13 cases), and the intraductal growth (IG) type (7 cases). Results. The patients with the MF type had a significantly higher incidence of lymph node metastasis (44.8%), as compared to those with the PI or IG type (15.0%). Two patients who died of hepatic failure during their hospital stay were excluded from this survival study. The cumulative 1-, 3-, and 5-year survival rates in 49 patients who underwent liver resection were 68.2%, 44.1%, and 32.4%, respectively. The patients with the IG type had the best outcome, followed by those with the PI type and MF type. The survival rates with or without lymph node metastasis were 9.0% and 60.6% at 3 years, and 9.0% and 42.9% at 5 years, respectively (P 0.05). The 1-, 2-, and 3-year survival rates in the MF-type patients with lymph node metastasis were 25.4%, 16.9%, and 0%, respectively. Eight patients (15.7%) survived for more than 5 years after operation. The gross appearance of these tumors was the PI type in 5 patients, the IG type in 2, and the IG + MF type in 1. Except for one case with the PI-type tumor, lymph node metastasis was not observed. All of the 5-year survivors underwent curative resection and none of them had any positive surgical margin. Conclusion. Analysis of the clinicopathologic factors influencing the survival after surgical treatment showed that the macroscopic type, surgical curability, lymph node metastasis, tumor size, and cancer-free margin were the most predictive.     

Recurrence after surgical resection of intrahepatic cholangiocarcinoma

We aimed to assess the patterns of recurrence after surgery for intrahepatic cholangiocarcinoma (ICC) and the outcomes of treatment in patients with recurrence. From 1981 to 1999, 123 patients with ICC underwent hepatectomy. The 3-year and 5-year survival rates were significantly higher in patients after curative resection (n = 56; 53%, 50%) than in patients after noncurative resection (n = 67; 7%, 2%; P < 0.0001). In 54 patients followed-up after curative resection, the rate of recurrence after surgery was 46%. The recurrences were in the liver (56%), abdomen (disseminated; 24%), and lymph nodes (20%). The rates of recurrence were significantly higher in patients with various classifications of mass-forming ICC tumors (P = 0.039) than in those with other types of tumors, and in patients with tumors over 3 cm in greatest diameter than in those with tumors 3 cm or less (P = 0.006). Hepatic recurrence, abdominal dissemination, and intraductal recurrence were significantly related to tumors that included mass-forming ICC (P = 0.002), tumors that included periductal infiltrating ICC (P = 0.009), and tumors that included intraductal growth ICC (P = 0.038), respectively. Seven patients with recurrence underwent radiation, chemotherapy, immunotherapy, or surgical resection. Only 2 patients, with intrahepatic metastasis and intraductal recurrence, respectively, had good outcomes after surgery. The effectiveness of other treatments has not been established.     

Analysis of the relationships between clinicopathologic factors and survival time in intrahepatic cholangiocarcinoma

BACKGROUND: This study elucidated the relationships between various clinicopathologic factors and the outcome of patients with intrahepatic cholangiocarcinoma (ICC) treated by hepatic resection. METHODS: A total of 37 ICC patients were treated by hepatic resection in our department between March 1979 and March 2001. Eleven clinicopathological variables (age, sex, preoperative jaundice, operative curability, number of tumors, UICC [Union Internationale Contre le Cancer] pT factor, UICC pN factor, UICC pM factor, histological tumor type, 10-year period during which they initially examined, and adjuvant therapy) were selected for univariate and multivariate analysis to evaluate their influence on the outcome. RESULTS: The actuarial 1-, 3-, and 5-year survival rates in the 37 resected cases were 54.1%, 34.0%, and 23.9%, respectively. The stage of the ICC influenced their overall survival rate. The univariate analysis revealed that curative resection (P = 0.0018), UICC pT factor (P = 0.0445), pN factor (P = 0.0029), pM factor (P = 0.0022), and histological type (P = 0.0030) were significant risk factors for survival. Multivariate analysis revealed that noncurative resection, lymph node metastasis, and less differentiated histological type were significant risk factors for poor outcome. All 6 of the 37 patients who survived more than 5 years had undergone curative resection, all of their tumors were well differentiated, and none had lymph node metastasis. CONCLUSIONS: Curative surgical resection remains the only effective approach to the treatment of ICC. Extensive resection is not indicated if lymph node metastasis can be identified preoperatively or intraoperatively. Current adjuvant therapy is ineffective, and it will be necessary to assess the efficacy of new adjuvant therapy strategies or the addition of new agents in terms of the outcome of ICC.     

肝内胆管癌的诊断与治疗(附12例报告)

目的探讨肝内胆管癌发病的诊治方法。方法对我院1990年1月至2003年3月经手术和病理证实的12例肝内胆管癌病例资料进行回顾性分析。结果早期症状无特异性，AFP检查均为阴性，血CEA检查升高显著3例，4例术前诊断为肝内胆管癌，8例误诊，本组行根治性切除5例(41．6％)，姑息性手术7例。结论肝内胆管癌误诊率高，根治性手术率低，熟悉本病的临床特征，B超检查仍是首选方法。术中病理学检查是避免误诊漏诊的重要方法，根治性手术切除是本病最有效的治疗方法。     

Indications for surgical treatment of intrahepatic cholangiocarcinoma with lymph node metastases

BACKGROUND/PURPOSE: The postoperative outcome of patients who have intrahepatic cholangiocarcinoma with lymph node metastases is extremely poor, and the indications for surgery for such patients have yet to be clearly established. METHODS: The demographic and clinical characteristics of 133 patients who underwent lymph node dissection during hepatic resection of intrahepatic cholangiocarcinoma were retrospectively analyzed. RESULTS: Multivariate analysis identified three independent prognostic factors: intrahepatic metastasis, nodal involvement, and tumor at the margin of resection. Of the patients with tumor-free surgical margins, none of the 24 patients who had both lymph node metastases and intrahepatic metastases survived for 3 years. In contrast, the survival rates for the 23 patients who had lymph node metastases associated with a solitary tumor were 35% at 3 years and 26% at 5 years. CONCLUSIONS: Surgery alone cannot prolong survival when both lymph node metastases and intrahepatic metastases are present, while surgery may provide a chance for long-term survival in some patients who have lymph node metastases associated with a solitary intrahepatic cholangiocarcinoma tumor.     

肝内胆管细胞癌预后影响因素分析及生存列线图建立

目的探讨肝内胆管细胞癌(ICC)切除术后预后相关影响因素及建立有效的列线图生存预测模型。方法回顾性分析2010年1月—2018年12月在西安交通大学第一附属医院行手术切除的160例ICC患者的临床病理资料,其中男性89例,女性71例;年龄(57.41±10.35)岁,年龄范围29~81岁。观察指标:(1)患者随访的结果,术后生存情况;(2)影响患者术后预后的单因素及多因素分析;(3)列线图模型的建立及验证。采用门诊和电话方式进行常规随访,术后1年内每3个月复查肝功能、CA19-9、上腹部B超、CT或MRI检查。随后每3~6个月随访1次。观察终点为术后总体生存时间,即为手术日期到随访截止日期,或因肿瘤复发及转移致死亡的日期。随访截至2019年8月1日。将患者临床病理资料纳入预后影响因素分析,单因素分析采用Kaplan-Meier法和Log-rank检验,多因素分析采用Cox比例风险回归模型。基于Cox比例风险回归模型筛选的独立危险因素建立列线图生存预测模型。将160例患者按7∶3的比例分为模型组(n=112)及验证组(n=48),模型组用于生存列线图的建立,验证组用于其预测能力的评估,通过一致性指数(C-index)评估列线图模型对ICC患者术后生存预测的准确性。正态分布的计量资料以均数±标准差(Mean±SD)表示,偏态分布的计量资料以M(范围)表示。计数资料用例数和百分比(%)表示。结果160例ICC术后患者,随访期间死亡100例,死亡原因均为肿瘤复发转移致多器官功能衰竭,存活60例,生存时间20个月(2~111个月),1、3、5年总体生存率分别为63.3%、30.0%、19.6%。单因素分析结果显示,CA19-9、肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度、肿瘤细胞类型、肿瘤直径、脉管侵犯、TNM分期、淋巴结转移、卫星灶及切缘状态是ICC患者的预后影响因素(HR=1.78,1.97,2.91,1.89,3.06,2.86,2.07,1.94,2.24,1.95,2.68,2.00,95%CI:1.12~2.85,1.22~3.16,1.85~4.56,1.26~2.85,1.38~6.82,1.31~6.25,1.37~3.14,1.07~3.51,1.24~4.06,1.26~3.01,1.28~5.60,1.11~3.59,P<0.05)。多因素分析结果显示,肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度(低分化)及肿瘤细胞类型是影响ICC患者预后的独立危险因素(HR=2.47,2.37,2.06,5.52,5.72,95%CI:1.39~4.38,1.44~3.91,1.25~3.40,1.24~24.49,2.31~14.17,P<0.05)。列线图的建立基于5个独立危险因素,模型组的列线图预测术后生存的C-index值为0.71(95%CI:0.64~0.79),验证组C-index值为0.71(95%CI:0.61~0.81)。结论基于肝内胆管结石、肿瘤数目、肝脏切除范围、肿瘤分化程度和肿瘤细胞类型等影响ICC患者术后生存的独立危险因素构建的列线图生存预测模型具有较好的准确度。     

Prognostic factors for patients with mass-forming intrahepatic cholangiocarcinoma: A case series of 68 patients

BACKGROUNDIntrahepatic cholangiocarcinoma (ICC) is the second most common primary liver cancer in humans after hepatocellular carcinoma and a rare epithelial malignancy that results in a poor prognosis. According to the Liver Cancer Study Group of Japan classification, ICC can be divided into three types: Mass-forming (MF) type, periductal-infiltrating (PI) type, and intraductal-growth type. The MF type is the most common, accounting for 57.1-83.6% of ICCs. Nevertheless, little is known about the epidemiology and treatment of MF ICC.AIMTo examine the prognostic factors for patients with MF ICC.METHODSWe carried out a retrospective analysis of consecutive patients with MF ICC treated at the Faculty of Hepato-Pancreato-Biliary Surgery of Chinese PLA General Hospital between January 2008 and December 2018. According to the treatment received, the patients were divided into either a resection group or an exploration group.RESULTSThe pooled 1-, 3-, and 5-year survival rates in the 68 patients with MF ICC were 66.5%, 36.3%, and 9.3%, respectively. Univariate analysis revealed that surgical resection (P < 0.001), nodal metastasis (P < 0.001), tumor location (P = 0.039), vascular invasion (P < 0.001), ascites (P < 0.001), and differentiation (P = 0.009) were significantly associated with the prognosis and survival of MF ICC. Multivariate analysis revealed that ascites (hazard ratio [HR] = 5.6, 95% confidence interval [CI]: 1.6-18.9, P = 0.006) and vascular invasion (HR = 2.5, 95%CI: 1.0-6.1, P = 0.045) were independent risk factors for MF ICC. The pooled 1-, 3-, and 5-year survival rates in the 19 patients of the exploration group were 5.3%, 5.3%, and 0, respectively. Among the 49 patients who underwent surgical resection, the pooled 1-, 3-, and 5-year survival rates were 93.5%, 49.7%, and 14.4%, respectively. Univariate and multivariate analyses revealed that vascular invasion (HR = 3.1, 95%CI: 1.2-8.5, P = 0.024) and nodal metastasis (HR = 3.2, 95%CI: 1.4-7.6, P = 0.008) were independent prognostic risk factors for surgical resection patients.CONCLUSIONThe prognosis of MF ICC patients is dismal, especially those with ascites or vascular invasion. Surgical resection is a key factor in improving overall survival in patients with MF ICC, and vascular invasion and lymph node metastasis affect the efficacy of surgical resection.     

Extended right hepatic lobectomy with resection of inferior vena cava and portal vein for intrahepatic cholangiocarcinoma

We report a case of intrahepatic cholangiocarcinoma treated by extended right lobectomy and resection of the inferior vena cava (IVC) and portal vein. A 53-year-old man was referred with elevated serum alkaline phosphatase (ALP) and γ-glutamyl transpeptidase (γ-GTP) levels on April 23, 1999. He was not jaundiced and did not have any symptoms. Endoscopic retrograde cholangiopancreatography (ERCP) revealed irregular strictures in both the anterior and posterior segmental ducts. Contrast-enhanced computed tomography (CT) scan demonstrated a low-density tumor with an unclear margin in the right lobe of the liver. The patient underwent extended right hepatic lobectomy and total caudate lobectomy. Partial resection of the IVC (6 cm) was performed under total hepatic vascular exclusion. The main portal trunk and left portal vein were resected and reconstructed with an end-to-end anastomosis. Macroscopically, a 5.0 × 5.0 × 4.5-cm periductal infiltrating-type tumor occupied the right hepatic parenchyma along the posterior and anterior segmental ducts. Histological examination revealed moderately differentiated tubular adenocarcinoma with marked perineural invasion. Lymph node metastasis was observed in the hepatoduodenal ligament and posterior surface of the pancreatic head. The resected margins of the common bile duct and left hepatic duct were free of tumor. The patient's postoperative course was uneventful, and he was discharged from hospital on the 28th postoperative day. Nine months after the operation, he suddenly developed obstructive jaundice, and died with recurrent disease. This is the first reported case of intrahepatic cholangiocarcinoma treated with major hepatectomy and resection of the IVC and portal vein except ex situ procedure. This aggressive surgical approach may offer hope for patients with intrahepatic cholangiocarcinoma involving the IVC. Received: March 27, 2000 / Accepted: August 8, 2000     

末梢型肝内胆管细胞癌的诊断及外科治疗效果分析

目的 探讨末梢型肝内总胆管细胞癌（PIHCC）的诊断及外科治疗结果,以提高其诊治水平。方法 回顾性分析1970－1999年间外科治疗的20例PIHCC患者诊断、治疗及预后的资料。结果 （1）本病缺乏特异性临床表现,部分病例可并发乙型肝炎（35．0％）、肝硬化（45．0％）和血清AFP升高（25．0％）;（2）影像学检查：B超、CT、MRI及ECT的诊断率分别为90．0％（18／20）、94．4％（17／18）、3／3及4／3;（3）手术切除率为60％,全组病例的1、3、5年生存率分别为55．0％（11／20）、35．0％（7／20）及20．0％（4／20）,其中肝切除术病例分别为83．3％（11／12）、58．3％（7／12）、33．3％（4／12）;（4）生存5年以上的4例患者中,直径≤3cm的小肝癌3例、包膜完整的结节型大肝癌1例,且术后均辅助选择性肝动脉灌注化疗,有助于生存率的提高。结论 本病缺乏特异性血清肿瘤标志物,治愈性切除术（包括术后辅助治疗）可获得良好生存率。