可切除肝门部胆管癌患者临床病理特征及预后影响因素分析

目的:探讨可切除肝门部胆管癌（hilar cholangiocarcinoma,HC）患者术前血清CEA、CA19-9水平与临床病理因素的相关性，并进一步分析上述各因素与HC患者行根治术后预后的相关性。方法:回顾性分析2012年1月至2018年1月中国医科大学附属盛京医院收治的109例行根治性切除的HC患者的临床病理资料，研究术前血清CEA、CA19-9水平与各临床病理特征的相关性，并进一步分析上述各因素与HC患者行根治性切除术后预后的相关性。结果:术前血清CEA水平与HC各临床病理特征无关（P＞0.05）。术前黄疸越重，血清CA19-9水平越高（P＜0.05）。肿瘤侵犯血管的HC患者，术前血清CA19-9水平较高（P＜0.05）。HC患者TNM分期越晚，术前血清CA19-9水平越高（P＜0.05）。门静脉侵犯、淋巴结转移、TNM分期以及术前血清CA19-9水平是影响HC患者术后1年生存率的危险因素（P＜0.05），其中淋巴结转移、门静脉侵犯、CA19-9是影响患者术后1年生存率的独立危险因素（P＜0.05）。结论:可切除HC患者术前血清CA19-9水平与临床分期及血管侵犯情况存在一定相关性；早期 HC患者行根治性切除术后预后较好，提高HC早期诊断率有助于进一步改善HC患者的生存预后；结合术前血清CA19-9水平、门静脉侵犯及淋巴结转移等多种因素可预测HC患者行根治性切除术后的生存率。

Clinicopathological features and prognostic factors of resectable hilar cholangiocarcinoma

Objective:To investigate the correlation between preoperative serum CEA,CA19-9 level and clinicopathological factors in patients with resectable hilar cholangiocarcinoma (HC),and to further analyze the correlation between the above factors and the postoperative survival rate of these patients.Methods:The clinical and pathological data of 109 patients with HC who underwent radical resection from January 2012 to January 2018 in Shengjing Hospital Affiliated to China Medical University were retrospectively analyzed.The correlation between preoperative serum CEA/CA19-9 level and clinicopathological features and the correlation between the above factors and the postoperative survival rate of these patients were analyzed.Results:There was no significant correlation between clinicopathological features of HC and preoperative CEA level(P＞0.05).The more severe the preoperative jaundice get,the higher the serum CA19-9 level is(P＜0.05).The preoperative serum CA19-9 level was relatively high in patients with vascular invasion(P＜0.05).The later the TNM stage was,the higher the preoperative serum CA19-9 level was,and the difference was statistically significant(P＜0.05).Portal vein invasion,lymph node metastasis,TNM staging and preoperative serum CA19-9 levels were risk factors for 1-year survival of HC patients who underwent radical resection (P＜0.05).Among them,lymph node metastasis,portal vein invasion and CA19-9 were independent risk factors for 1-year survival of these patients.Conclusion:Preoperative serum CA19-9 levels in patients with resectable HC were correlated with clinical stages and vascular invasion.Early HC patients have better prognosis after radical resection.Increasing the early diagnosis rate of HC is helpful to improve the survival and prognosis of HC patients.Preoperative serum CA19-9 level,portal vein invasion and lymph node metastasis can be used to predict the survival rate of HC patients after radical resection.