肝内胆管细胞癌的外科治疗及预后因素分析

Surgical management and prognosis of 80 cases with intrahepatic cholangiocarcinoma

目的探讨肝内胆管细胞癌(ICC)患者的外科治疗方法和影响手术预后的因素。方法回顾性分析80例经手术治疗的ICC患者的临床病理资料,对其中71例肿瘤切除的患者行术后生存预后的单因素和多因素分析。结果本组80例手术患者术后中位生存时间为21.5月,1、3、5年生存率为68.6%、40.3%、25.4%。根治性手术切除组和姑息性手术切除组的中位生存时间分别为40个月及15个月,两组间比较差异有统计学意义(掊2=13.62,P<0.001)。本组总的肿瘤切除率为88.8%(71/80),对可能影响患者肿瘤切除术后生存的15个因素分别进行单因素分析,结果表明肿瘤大小、肿瘤数目、淋巴结转移、术前血清CA19-9水平、手术切缘及邻近组织器官侵犯对预后有影响(P<0.05)。COX模型多因素分析结果表明手术切缘和肿瘤数目是两个独立预后因素。结论手术切除是ICC的首选治疗方法,R0切除和单个肿瘤是评估ICC患者肿瘤切除术后取得良好预后的独立指标。

Objective To analyze surgical management and identify prognostic factors after surgical management of intrahepatic cholangiocarcinoma（ICC）. Methods Clinical and pathological data of 80 patients who underwent surgery management for ICC were analyzed. Prognostic factors were identified by Cox regression model in those underwent surgical resection. Results Median overall survival after surgical treatment of 80 ICCs was 21.5 months, 1-, 3-, and 5-year overall survival was 68.6%,40.3%, and 25.4%, respectively. Median survival of the Curative resection group and the palliative resection group was 40 months and 15 months respectively （X^2 = 13.62,P 〈 0.001 ）. The overall rate of surgical resection of 80 ICCs was 8g.g%（71/80）. Univariate analyses showed that tumor size, tumor number, lymph node involvement, preoperative serum CA19-9 levels, surgical margin, as well as invasion of adjacent organs, were of prognostic factors （P 〈 0.05） . COX multivariate analysis showed that surgical margins and the number of tumor were the two independent prognostic factors for ICC patients. Conclusions Surgical resection is the preferred treatment for ICC. Patients with R0 resection and single tumor have favorable surgical outcomes.