肝内胆管癌患者临床病理特征与变化的研究及预后分析

目的 通过对肝内胆管癌患者的临床病理特征与变化进行分析,为肝内胆管癌的预后分析提供参考.方法 选取确诊并治疗的肝内胆管癌患者126例,对患者的临床资料进行回顾性分析,包括患者的一般资料、血液学结果、病理资料等,对数据进行统计学分析.结果 55例行根治性切除手术患者的1、3、5年生存率分别为83.8％、64.1％和59.3％,71例采用姑息放化疗患者的1、3、5年生存率分别为63.1％、35.3％和29.7％.Log-rank检验显示,不同血清CA19-9值(χ2=7.092,P=0.001)、不同手术切缘大小(χ2=5.983,P=0.015)、是否存在血管浸润(χ2=6.052,P=0.020)、是否存在远处转移(χ2=23.781,P=0.001)患者的生存率比较,差异有统计学意义.Cox比例风险回归模型结果显示,血清CA19-9与手术切缘是影响患者预后的独立因素.结论 根治性切除术是治疗肝内胆管癌最有效的外科治疗方法,血清CA19-9水平是对患者预后分析非常有价值的临床指标,而足够的手术切缘是影响预后的主要因素.

Clinicopathological characteristics and changes of intrahepatic cholangiocarcinoma and prognostic analysis

Objective To analyze the clinicopathological features and changes of intrahepatic cholangiocarcinoma, and to provide reference for the prognosis. Method A total of 126 patients with intrahepatic cholangiocarcinoma were retrospectively analyzed. The clinical data, including general profiles, hematology test results, imaging data, pathology da-ta, were statistically analyzed. Result Among the 55 patients with radical resection, the 1-, 3-and 5-year survival rates were 83.8％, 64.1％and 59.3％, respectively, while the survival rates of another 71 patients treated with palliative chemo-therapy were 63.1％, 35.3％and 29.7％, respectively. The Log-rank test showed that serum CA19-9 (χ2=7.092, P=0.001), surgical margin (χ2=5.983, P=0.015), vascular invasion (χ2=6.052, P=0.020) and distant metastasis (χ2=23.781, P=0.001) were statistically different in patients with varied survival rates. Cox proportional hazards showed that serum CA19-9 and surgical margins were independent factors influencing the prognosis of patients. Conclusion Surgical radical resection is the most effective surgical treatment for intrahepatic cholangiocarcinoma. Serum CA19-9 level is a very valuable clinical prognostic marker, besides, adequate surgical margin is the main factor affecting prognosis.