用T-分期系统回顾性分析47例肝门部胆管癌

Retrospective analysis of 47 cases with hilar cholangiocarcinoma using T-staging system

目的 评价纽约Sloan Kettering肿瘤中心采用的肝门部胆管癌术前T 分期系统的临床应用价值。方法 回顾性分析 1997年 12月 - 2 0 0 2年 12月间 4 7例符合要求的肝门部胆管癌患者的术前影像学资料 ,并按照T 分期系统的标准进行分期。分析不同T 分期肿瘤切除率、切缘阴性率及术后生存率的差异 ,并分析不同影像学方法的诊断符合率。结果 T1期 2 0例 ,T2 期 2 3例 ,T3 期 4例 ;各分期的切除率分别为 70 %、4 8%和 0 % ,差异显著 (P =0 0 13)。随着分期的增高 ,切缘阴性率显著下降 (P =0 0 18)。T1、T2 和T3 期的 1年累积生存率分别为 6 0 %、39%和 0 % ;3年累积生存率分别为35 %、9%和 0 % ;各分期的生存率有显著性差异 (P =0 0 10 )。MRCP +多普勒彩超联合检查的确诊率明显高于MRCP +B超及CT或SCT +多普勒彩超 (P =0 0 0 7)。结论 T 分期系统有较好的术前评价作用 ,可用作判断肝门部胆管癌的可切除性及预后。术前联合MRCP和多普勒彩超检查有助于确定肿瘤范围及T 分期。

Objective To evaluate the clinical value of T staging system for hilar cholangiocarcinoma which was adopted in memorial Sloan Kettering cancer center of New York. Methods The image data of these 47 patients were analyzed retrospectively from December 1997 to December 2002 whose data were according with our demand, and they were staged into three stage according to the criteria of the T staging system. The difference of respectability, ratio of tumor free resection margin and actuarial survival rate were analyzed for different T staging. And the coincident ratio of three different kinds of imaging methods was also analyzed. Results Twenty patients had T 1 tumors, twenty three had T 2 tumors and four had T 3 tumors. The resectability of the three stage was 60%, 39% and 0% respectively, and the difference was significant ( P =0 013). The likelihood of achieving tumor free margin decreased progressively with increasing T stage ( P =0 018). The cumulative 1 year survival rates of T 1, T 2 and T 3 patients were 60%, 39% and 0% respectively, and the cumulative 3 year survival rate was 35%, 9% and 0% respectively, the survival of different stage patients differed markedly( P =0 0103). The coincident ratio of combined using MRCP and color Doppler ultrasonagraphy was higher than that of combined using MRCP and B ultrasonagraphy or combined using CT/SCT and color Doppler ultrasonagraphy ( P =0 007). Conclusions The T staging system has a better value for preoperative assessment, and can be used to judge resectability and survival of hilar cholangiocacinoma. It will be helpful to use MRCP and color Doppler Ultrasonagraphy combined to verdict the coverage of the tumor and the T staging preoperatively