肿瘤负荷评分在获得根治性切除肝内胆管癌患者预后预测中的价值

目的 研究肿瘤负荷评分(tumor burden score，TBS)对肝内胆管癌(intrahepatic cholangiocarcinoma，ICC)患者根治性切除术后预后的预测价值。方法 回顾性分析2005年1月至2011年12月在复旦大学附属中山医院肝肿瘤外科连续收治的322例行根治性切除术的ICC患者资料，随访截止至2014年4月。采用ROC曲线评价TBS预测总体生存率(OS)的准确性。多因素Cox回归分析影响ICC患者预后的独立因素。结果 中位随访时间44.0个月(范围2.7～100.5)。TBS将322例ICC患者分为低、中和高三个预后风险组(104例、176例和42例)。TBS与血清CA199(P=0.004)、术前中性粒细胞/淋巴细胞比值(NLR，P=0.001)、淋巴细胞/单核细胞比值(LMR，P<0.001)、肿瘤最大径(P<0.001)、肿瘤数目(P=0.001)、淋巴结转移(P<0.001)及TNM分期(P<0.001)显著相关。TBS预测ICC患者术后5年OS的曲线下面积(AUC)为0.632(P<0.001)，高于NLR≥2...

Prognostic value of tumor burden score in patients with intrahepatic cholangiocarcinoma after curative hepatic resection

Objective To evaluate the prognostic value of tumor burden score (TBS) in patients with intrahepatic cholangiocarcinoma (ICC) after curative hepatic resection. Methods The clinical data of 322 consecutive ICC patients who underwent a curative hepatic resection at Zhongshan Hospital between Jan. 2005 and Dec. 2011 were collected. The study was censored on Apr. 2014. Time-dependent ROC analysis was conducted to evaluate the ability of TBS in predicting overall survival (OS). Multivariate Cox regression analysis was performed using the Cox proportional hazards regression to determine the independent prognostic factors for ICC patients. Results The median follow-up time was 44.0 months (range 2.7-100.5 months). TBS stratified 322 ICC patients into low, medium and high, three prognostic risk strata (104, 176 and 42, respectively). TBS was significantly associated with serum CA199 (P=0.004), preoperative NLR (P=0.001), LMR (P< 0.001), diameter of the largest tumor nodule (P< 0.001), tumor number (P=0.001), lymph node metastasis (P< 0.001) and TNM stage (P< 0.001), respectively. ROC curve analysis demonstrated that the AUC of TBS for predicting the 5-year OS rate of ICC patients was 0.632, which was significantly better than that of preoperative NLR≥ 2.49 (0.603, P=0.002) and LMR≥ 4.45 (0.596, P=0.003) , respectively. Kaplan-Meier survival analysis showed that the 1-, 3-, and 5-year RFS in the low TBS group were 71.4%, 52.1% and 40.2%, respectively; which were significantly better than those in the medium TBS group (54.4%, 36.6% and 32.0%, respectively; P=0.0262) and the high TBS group (26.3%, 13.2% and 13.2%, respectively; P< 0.0001). The 1-, 3-, and 5-year OS in the low TBS group were 87.5%, 63.8% and 50.6%, respectively; which were significantly better than those in the medium TBS group (73.8%, 42.1% and 31.0%, respectively; P< 0.0001) and the high TBS group (48.9%, 31.1% and 13.8%, respectively; P< 0.0001). Multivariate Cox regression analysis demonstrated that TBS was an independent prognostic factors for postoperative RFS (HR=2.482, 95%CI 1.560-3.947, P< 0.001) and OS (HR=4.759, 95%CI 2.553-8.870, P< 0.001) of ICC patients, respectively. Conclusion TBS is an independent prognostic factor for ICC patients after curative hepatic resection. TBS may be a good tool for predicting the postoperative prognosis of ICC patients.