改良T分期应用于肝门部胆管癌的临床价值

目的 评价改良T分期用于肝门部且日管癌术前评估与预后判断的临床价值.方法 回顾性分析1999-2007年98例肝门部胆管癌患者的If缶床资料,按改良T-分期标准分期;采用χ~2检验、Log rank及Breslow检验评析不同分期的切除率、根治性切除率、联合肝叶及门静脉部分切除率、较低组织分化及淋巴结转移率与生存率差异.结果 T1、T2、,13期分别有43、37、18例,切除率为65%、40%、11%,根治性切除率为46%、21%、0,均随T分期升高而下降(前者χ~2=15,P<0.01;后者χ~2=14,P<0.01);T1与T2期切除病例中分别有60%与73%联合肝叶切除(χ~2=0.6,P>0.05)、3%与33%联合门静脉部分切除(χ~2=4,P<0.05)、71%与40%较低分化类型(χ~2=4,P<0.05)、50%与40%淋巴结转移(χ~2=0.4,P>0.05);T1与T2期1、3、5年生存率分别为58%、30%、18%与43%、11%、0%,而T3期1、2年生存率依次为12%、0,T1与T2期显著高于T3期(T1与T3:Log rank χ~2=14,Breslow χ~2=12,P<0.01;T2与13:Log rank χ~2=6,Breslow χ~2=4,P<0.05),T1与T2期差异无统计学意义(Log rank χ~2=2,Breslow χ~2=1,P值均>0.05).结论 改良T分期有较好的术前评估作用;但仍需阐明其与组织分化和淋巴结转移的相关性.

The evaluation on modified T-staging system for hilar cholangiocarcinonm

Objective To evaluate the clinical significance of a modified T-staging system for hilar cholangiocarcinoma(HCC).Methods From 1999 through 2007,98 HCC patients were stratified by the Tstaging system.Statistical differences were evaluated for resectability,radical resectability,concomitant partial hepatectomy,partial portal vein resection,histological differentiation,lymph node characteristic and survival rate.Results There were 43 HCC patients graded at T1,37 at T2 and 18 at T3 respectively.The resectability rates were 65%,40% and 11%,and radical resection was achieved in 46%,21% and 0% respectively.Resectabilities decreased with increasing T stage(χ~2=15,P<0.01;χ~2=14,P<0.01,separately).In patients with T1 and T2 tumors who underwent resection,the concomitant partial hepatectomy accounted for 60% and 73%(χ~2=0.6,P>0.05),partial portal vein resection for 3% and 33%(χ~2=4,P<0.05),poor differentiated types for 71% and 40%(χ~2=4,P<0.05),and lymph node metastasis for 50% and 40%(χ~2=0.4,P>0.05),respectively.The 1-,3-and 5-year survival rates in patients with T1 lesions were 58%,30%and 18%,in 12 patients it was 43%,11%and 0.The 1-and 2-year survival rate in T3 patients was 12%and 0.Patients witll T1 or T2 stage tumors had a significantly longer survival than those with T3(P<0.05)(Log rank χ~2=14,Breslow χ~2=12,P<0.01;Log rank χ~2=6,Breslow χ~2=4,P<0.05,individually),and the difference in survival between T1 and T2 was not significant(Log rank χ~2=2,Breslow χ~2=1,P>0.05).Conclusions The T-staging system is appropriate for preoperative evaluation in HCC patients.However,its correlation with tumor histological differentiation and lymphatic characteristics needs to be elucidated.