影响老年人肝内胆管细胞癌手术预后的因素分析

Factors influencing postoperative prognosis of elderly patients with intrahepatic cholangiocarcinoma

目的探讨老年肝内胆管细胞癌手术治疗预后相关因素,提高其诊断和治疗水平。方法回顾性对比分析我院1988年10月至2007年10月手术治疗的老年(≥65岁)肝内胆管细胞癌36例与非老年(<65岁)肝内胆管细胞癌32例的临床资料。采用Kaplan-Meier法统计术后生存期并进行单因素分析,Cox回归法进行多因素分析。结果老年组行根治性切除者1、3、5年生存率与行姑息性切除者相较,差异有统计学意义(P<0.01);CEA>10μg/L者1、3、5年生存率与≤10μg/L者相较差异有统计学意义(P<0.01)。多因素分析根治性切除术、CEA是术后生存的独立影响因素。结论老年人肝内胆管细胞癌以手术治疗为主,CEA水平和根治性切除术是影响其预后的主要因素。

Objective To investigate factors influencing postoperative prognosis of elderly patients with intrahepatic cholangiocarcinoma（ICC）in order to improve clinical diagnosis and treatment. Methods A retrospective analysis of consecutive 36 elderly patients（≥65 years old）undergoing hepatectomy for ICC from Oct. 1988 to Oct. 2007 was performed, and 32 patients younger than 65 years served as controls. The data were analyzed by Kaplan-Meier method and Cox regression. Results In the elderly group, the 1-,3- and 5-year survival rate with radical excision was significantly higher than that with non-radical excision（P〈0. 01）. The 1-, 3- and 5-year survival rate with a low CEA level（≤ 10 μg/L）was significantly higher than that with a high CEA level（〉10 μg/L, P〈0. 01 ）. Multifactor analysis with the Cox proportional-hazards model indicated that radical excision, and CEA level were independent factors influencing the prognosis. Conclusion Operation is the major treatment for the elderly patients with ICC. CEA level and radical excision are major factors influencing the prognosis of elderly ICC patients.