肝内胆管细胞癌淋巴结转移与预后的关系

Lymph node metastasis of patients with intrahepatic cholangiocarcinoma

目的探讨淋巴结转移对肝内胆管细胞癌(ICC)患者预后的影响。方法对随访到的132例自1996年12月至2003年6月在我院手术治疗的ICC患者的临床资料进行回顾性分析,采用Kap lan-m e ier法对确定的单因素进行生存率分析,采用χ2检验对各样本率之间进行比较,采用Logistic回归进行多因素分析,采用Log-rank法对单因素进行生存分析评价。结果肝十二指肠韧带淋巴结转移出现在所有术前29例以及术后48例淋巴结转移患者中,未发现“跳跃式”淋巴结转移。随访到的58例已死亡患者中,有36例经证实死于淋巴结转移,淋巴结转移是ICC患者术后主要死亡原因之一。Logistic回归统计学分析显示,肿瘤分化程度(χ2=4.071,P=0.044)以及浸润型胆管细胞癌与淋巴结转移的发生密切相关(χ2=3.872,P=0.037)。98例行根治性手术患者中,46例行淋巴结清扫与52例未行淋巴结清扫患者中位生存期分别为20个月和13个月,差异有统计学意义(χ2=9.82,P<0.01)。结论肝十二指肠韧带淋巴结可能为ICC的前哨淋巴结。对肝十二指肠韧带淋巴结转移的预防和积极治疗,可望提高ICC患者的生存率。

Objective To investigate the relationship between lymph node metastasis and prognosis in patients of intrahepatic cholangiocarcinoma （ICC）. Methods A retrospective clinical analysis was made in 132 cases of ICC, who admitted to our hospital from December 1996 to June 2003. Kaplan-meier method was used to calculate their survival rates, χ^2 test to compare the difference of sample rates. Logistic regression analysis was performed to determine the factors influencing lymph node metastasis and log-rank univariate analysis was used to assess the role of lymph node metastasis in the long-survival. Results Lymph node metastasis in hepatoduodenal ligament could be detected in all 29 preoperative and 48 postoperative lymph metastatic cases, without ＂jumping-metastasis＂. Lymph metastasis was one of the major causes of postoperative mortality, and resulted in 36 of 58 followed-up death postoperatively. According to logistic analysis, pathological types of the carcinoma （χ^2 = 4. 071, P = 0. 044 ） and periductal-infiltrating tumors （χ^2 = 3. 872, P = 0. 037 ）were significant predictors of lymph node metastasis. In all 98 radical resections, 46 cases performed skeletenization of the hepatoduodenal ligament while other 52 cases not. The median survival of the two groups was 20 months and 13 months respectively （ χ^2 = 9.82, P 〈 0. 01 ）. Conclusions Lymph nodes in the hepatoduodenal ligament may be sentinel nodes for ICC lymph node metastasis. Aggressive treatment of lymph node metastasis in the bepatoduodenal ligament is an important strategy to improve the long-survival of postoperative ICC patients.