术前血清CA19-9是肝门部胆管癌根治术患者预后的独立影响因素

Preoperative serum CA19-9 level is an independent prognostic factor of patients receiving radical surgery for hilar cholangiocarcinoma

目的确定术前CA19-9对肝门部胆管癌根治术患者预后判断最有价值的截点,并探讨肝门部胆管癌根治术患者预后的影响因素。方法来自第二军医大学东方肝胆外科医院行根治性手术治疗的肝门部胆管癌患者168例被纳入研究。首先分析术前血清CA19-9水平与肝门部胆管癌患者临床病理特征的关系,并应用ROC曲线法分析确认术前血清CA19-9水平对判断预后最有价值的截点;随后采用单因素模型分析预后的可能影响因素,进一步采用多因素模型分析得出预后的独立影响因素。结果术前血清CA19-9水平与肿瘤病理分期、有无淋巴结转移及肿瘤大小有关,术前血清CA19-9水平对预后判断最有价值的截点为150U/mL(P=0.000)。单因素模型分析显示年龄、肿瘤大小、分化程度、Bismuth-Corlette分型、门静脉侵犯、肝动脉侵犯、肝实质侵犯、术前减黄、淋巴结转移及切缘对预后有影响。多因素模型分析显示肿瘤分化程度、淋巴结转移、肝动脉侵犯、切缘及术前血清CA19-9水平仍然具有统计学意义,其OR值与95%置信区间分别为:3.359(1.440-7.837)、2.973(1.927-4.587)、2.096(1.271-3.455)、2.238(1.356-3.694)和2.954(1.890-4.618)。结论术前血清CA19-9是影响肝门部胆管癌根治术患者预后的独立影响因素,其对预后判断最有价值的截点是150U/mL;肿瘤分化程度、淋巴结转移、肝动脉侵犯及切缘也是肝门部胆管癌根治术患者预后的独立影响因素。

Objective To investigate the appropriate cut-off point of CA19-9 level for predicting the prognosis of patients with hilar cholangiocarcinoma （HC） after radical surgery, and to discuss other potential prognostic factors that may affect their prognosis. Methods Totally 168 patients who had undergone radical surgery for HC in Eastern Hepatobiliary Surgery Hospital were selected for this study. The relationship of preoperation serum CA19-9 level with the clinicopathological characteristics of HC patients was analyzed, and ROC curve was used to determine the appropriate cut-off point of CA19-9 level. The potential factors influencing the prognosis were analyzed by univariate model and the independent factors were analyzed by multivariate methods. Results Preoperative serum CA19-9 level was related to pathologic stage, lymph node metastasis, and tumor size in HC patients. The strongest univariate predictor among the categorized preoperative CA19-9 measures was CA19 9 level less than 150 U/mL （P=0. 000）. In univariate analysis, the age, tumor size, differentiation degree, Bismuth-Corlette classification, portal vein invasion, hepatic artery invasion, liver invasion, preoperative biliary drainage, lymph node metastasis, and resection margin were identified as significant prognostic factors of HC. Multivariable analysis showed that the differentiation degree, lymph node metastasis, hepatic artery invasion, resection margin and preoperative serum CA19-9 level were the independent prognostic factors of HC, with the OR values and 95~confidence interval （CI） being 3. 359 （1. 440-7. 837）, 2. 973 （1. 927-4. 587）, 2. 096 （1. 271-3. 455）, 2. 238 （1. 356-3. 694）, and 2. 954 （1. 890-4. 618）, respectively. Concision Our results demonstrate that preoperative serum CA19-9level is an independent prognostic factor for HC patients, and the most discriminative cut-off point of CA19-9 level for prognosis is 150 U/mI.. The differentiation degree, lymph node metastasis, hepatic artery invasion, and resection margin are also the independent prognostic factors of HC.