不同部位胆管癌患者术后生存的影响因素分析

背景与目的 目前，胆管癌（CCA）的首选治疗仍为外科手术，但术后复发率较高，患者生存率低。对CCA患者术后生存影响因素的分析将有助于优化手术策略，从而一定程度上改善患者预后。因此，本研究探讨不同部位CCA患者术后生存的影响因素，为临床提供参考。方法 回顾性分析2011年1月—2020年3月133例行手术治疗的CCA患者临床病理资料，其中，肝内胆管癌（iCCA）58例，肝门胆管癌（hCCA）30例，远端胆管癌（dCCA）45例，分析临床病理特征与患者生存的关系与预后影响因素。结果 iCCA患者术后1、2、3、5年的生存率分别为41.38%、22.41%、8.62%、3.45%，单因素分析显示，iCCA患者的术后生存与合并胆道结石、术前血清白蛋白（ALB）水平、凝血酶时间、CEA、CA125、CA19-9、Child-Pugh分级、肿块最大直径、是否R₀切除、淋巴结转移情况、肿瘤分化程度有关（均P<0.05）；多因素分析显示，术前ALB水平、凝血酶时间、CA19-9、Child-Pugh分级、肿块最大直径及是否R₀切除是iCCA患者术后生存的独立影响因素（均P<0.05）。hCCA患者术后1、2、3、5年的生存率分别为43.33%、20.0%、6.67%、3.33%，单因素分析显示，hCCA患者的术后生存与术前CEA水平、是否R₀切除、淋巴结转移情况、肿瘤分化程度、肿块最大直径、是否侵犯门静脉有关（均P<0.05）；多因素分析显示，是否行R₀切除、淋巴结转移情况、肿瘤分化程度、是否侵犯门静脉及肿块最大直径是hCCA患者术后生存的独立影响因素（均P<0.05）。dCCA患者术后1、2、3、5年的生存率分别为62.22%、31.11%、17.78%、14.29%，单因素分析显示，dCCA患者的术后生存与淋巴结转移情况、肿瘤分化程度有关（均P<0.05）。多因素分析显示，淋巴结转移情况、肿瘤分化程度及是否R₀切除是dCCA患者术后生存的独立影响因素（均P<0.05）。dCCA患者术后生存时间优于iCCA和hCCA患者，但差异无统计学意义（均P>0.05）。结论 不同部位CCA有大致共同的预后影响因素，通过评估这些因素有助于预测CCA预后，完善对CCA患者的分层标准，优化术前和术后治疗方案，延长患者生存时间。

Analysis of factors affecting postoperative survival of patients with cholangiocarcinoma in different histological sites

Background and Aims At present, surgical resection is still the preferred treatment choice for cholangiocarcinoma (CCA), but the postoperative recurrence rate is high and the survival rate of patients is low. The determination of influencing factors for postoperative survival of CCA patients may be helpful for optimizing surgical planning, and thereby, to a certain extent improving the prognosis of the patients. Therefore, this study was conducted to investigate the factors influencing the postoperative survival of patients with CCA arising from different histological sites, so as to provide reference for clinical treatment.Methods The clinicopathologic data of 133 patients with CCA undergoing surgical treatment from January 2011 to March 2020 were retrospectively analyzed. There were 58 patients with intrahepatic cholangiocarcinoma (iCCA), 30 patients with hilar cholangiocarcinoma (hCCA), and 45 patients with distal cholangiocarcinoma (dCCA). The relations of the clinicopathologic characteristics with the postoperative survival of patients were analyzed and the prognostic factors were determined.Results For iCCA patients, the 1-, 2-, 3- and 5-year survival rates were 41.38%, 22.41%, 8.62% and 3.45%, respectively. Univariate analysis showed that the concomitant bile duct stones, preoperative serum albumin (ALB) level, thrombin time, levels of CEA, CA125 and CA19-9, Child-Pugh grade, the maximum diameter of the mass, whether or not R₀ resection was achieved, lymph node metastasis and the histological grade were associated with the postoperative survival of iCCA patients (all P<0.05); multivariate analysis showed that the preoperative ALB level, thrombin time, CA19-9, Child-Pugh grade, maximum diameter of tumor and whether or not R₀ resection was achieved were independent influencing factors for the postoperative survival of iCCA patients (all P<0.05). For patients with hCCA, the 1-, 2-, 3- and 5-year survival rates were 43.33%, 20.0%, 6.67% and 3.33%, respectively. Univariate analysis showed that the preoperative CEA level, whether or not R₀ resection was achieved, presence of lymph node metastasis, degree of differentiation of the tumor, the maximum diameter of the mass and presence of the portal vein invasion were related to the postoperative survival of hCCA patients (all P<0.05); multivariate analysis showed that whether or not R₀ resection was achieved, presence of lymph node metastasis, histological grade, portal vein invasion and maximum diameter of tumor were independent influencing factors for the postoperative survival of hCCA patients (all P<0.05). For patients with dCCA, the 1-, 2-, 3- and 5-year survival rates were 62.22%, 31.11%, 17.78% and 14.29, respectively. Univariate analysis showed that the lymph node metastasis and histological grade were associated with the postoperative survival of dCCA patients (all P<0.05), multivariate analysis showed that the lymph node metastasis, histological grade and whether or not R₀ resection was achieved were independent influencing factors for the postoperative survival of dCCA patients (all P<0.05).Conclusion There are generally common prognostic factors for CCA arising from different histological sites. Evaluation of these factors may helpful for estimating the prognosis of CCA, improving the stratification standard of CCA patients, optimizing the preoperative and postoperative treatment of CCA patients, and lengthening the survival time.