肝内胆管癌根治性切除术后肿瘤复发转移的预后因素分析

目的：分析肝内胆管癌（IHCC）患者根治性切除术后肿瘤复发转移的危险因素。 方法：收集2002年1月—2008年5月行根治性切除手术治疗的125例IHCC患者的临床病理资料，分析全组患者术后无瘤生存率以及影响术后无瘤生存的不良预后因素。同时分析CA19-9水平与IHCC患者临床病理因素的关系。 结果：截至2013年5月，全组患者随访率为81%，中位随访时间30个月，109例患者出现肿瘤复发或转移。全组患者1、3、5年无瘤生存率分别为61.6%、27.2%、12.8%。多因素分析显示淋巴结转移（RR=3.990，95% CI=2.383~6.679，P<0.001），肿瘤直径>5 cm（RR=1.78，95% CI=1.190~2.663，P=0.005），CA19-9>200 U/mL（RR=1.734，95% CI=1.138~2.642，P=0.01）和多发肿瘤（RR=1.77，95% CI=1.114~2.812，P=0.016）是根治性切除术后影响肿瘤复发转移的独立危险因素。CA19-9浓度与淋巴结转移率密切相关（OR=3.208，95% CI=1.276~8.067，P=0.013）；CA19-9水平预测淋巴结转移的曲线下面积（AUC）达到0.696，灵敏度和特异度分别为75.0%和63.0%。 结论：淋巴结转移、肿瘤直径>5 cm、CA19-9>200 U/mL和多发肿瘤是IHCC患者根治术后复发转移的不良预后因素，且术前高CA19-9水平与淋巴结转移密切相关。

Prognostic factors for tumor recurrence and metastasis of intrahepatic cholangiocarcinoma after radical resection

Objective: To determine the risk factors for tumor recurrence and metastasis in patients with intrahepatic cholangiocarcinoma (IHCC) after radical resection. Methods: The clinicopathologic data of 125 IHCC patients undergoing radical resection between January 2002 and May 2008 were collected and reviewed. The postoperative tumor-free survival rate and unfavorable factors affecting postoperative tumor-free survival were analyzed and meanwhile, the relations of CA19-9 level with clinicopathologic actors were also analyzed. Results: The follow-up rate was 81% for the entire group of patients until May 2013 with a median follow-up of 30 months, and 109 patients developed recurrence or metastasis. The cumulative 1-, 3- and 5-year tumor-free survival rate for the entire group was 61.6%, 27.2% and 12.8%, respectively. Multivariate analysis showed that lymph node metastasis (RR=3.990, 95% CI=2.383-6.679, P<0.001), tumor size larger than 5 cm (RR=1.78, 95% CI=1.190-2.663, P=0.005), CA19-9 level over 200 U/mL (RR=1.734, 95% CI=1.138-2.642, P=0.01) and multiple lesions (RR=1.77, 95% CI=1.114-2.812, P=0.016) were independent risk factors for tumor recurrence and metastasis after radical resection. The CA19-9 level was significantly related to the lymph node metastasis rate (OR=3.208, 95% CI=1.276-8.067, P=0.013), and CA19-9 level yielded an area under the curve (AUC) of 0.696 for prediction of lymph node metastasis, with a sensitivity of 75% and specificity of 63%. Conclusion: Lymph node metastasis, tumor size larger than 5 cm, CA19-9 level over 200 U/mL, and multiple lesions are independent unfavorable factors for recurrence and metastasis in IHCC patients after radical resection, and high preoperative CA19-9 level is closely related to lymph node metastasis.