肝内胆管细胞癌患者的预后影响因素分析

Analysis of prognostic factors influencing the outcome of intrahepatic cholangiocarcinoma

目的分析影响肝内胆管细胞癌（ICC）患者预后的相关临床病理因素，并对ICC的外科治疗方式进行探讨。方法回顾性分析43例经病理证实为ICC患者的临床病理资料。43例ICC患者中，40例行肝切除术，2例在剖腹探查时行无水酒精注射，1例仅行剖腹探查。采用单因素和Cox回归模型对可能影响ICC患者术后生存的因素进行分析。结果全组43例患者的1、3和5年生存率分别为64．4％、30．9％和25．8％。40例行肝切除患者的术后1、3和5年生存率分别为74．7％、33．3％和27．8％。单因素分析结果显示，肿瘤直径、有无淋巴结转移、癌胚抗原（CEA）水平和TNM分期与ICC患者的术后生存显著相关（均P〈0．05）。Cox多因素分析结果显示，肿瘤直径和有无淋巴结转移是影响ICC患者术后生存的独立因素（均P〈0．05）。结论肿瘤直径和有无淋巴结转移是影响ICC患者术后生存的独立因素，CEA水平和TNM分期是影响ICC患者术后生存的重要因素。对ICC患者应选择行根治性肝切除术。

Objective To analyze the clinicopathologic factors influencing the outcome of surgically treated intrahepatic eholangiocareinoma （ICC） and to explore the proper treatment choice of ICC. Methods The clinicopathological data of 43 surgically treated ICC patients in our hospital were retrospectively analyzed. Of the 43 patients, hepatic resection was performed in 40 patients, ethanol injection in 2, and laparoscopie exploration alone in 1. Kaplan-Meier method and Cox regression model were used for the analysis of factors influencing survival after operation. Results The accumulative 1-, 3- and 5-year survival rates were 64.4% , 30.9% , 25.8% for the whole group, and 74.7%, 33.3%, 27.8% for the 40 patients with hepatic resection, respectively. Univariate analysis revealed that tumor size, carcinoembryonie antigen （CEA） level, lymph node involvement and TNM stage were factors significantly affecting the survival （P 〈 0.05 ）. Cox multivariate analysis demonstrated that only tumor size and lymph node involvement were the independent factors significantly affecting the survival（ P 〈 0.05 ）. Conclusion Our results show that tumor size and lymph node involvement are independent factors affecting the survival. CEA level and TNM stage are important prognostic factors for surgical management. Radical resection is still the optimal treatment for patient with intrahepatic cholangiocarcinoma.