影响胆管癌预后的因素研究

Research on Related Factors for Prognosis in Patients with Cholangiocarcinoma

目的探讨胆管癌临床病理特征及术中、术后特点与预后的关系。方法回顾性分析2004年1月-2010年12月中国人民解放军总医院678例胆管癌术后患者,其中有随访结果 397例,仅对手术切除的胆管癌且非手术原因死亡的患者293例进行Cox比例风险模型分析。对所有指标进行单因素及多因素分析。结果 293例胆管癌患者中位随访时间为55.9个月,截止随访终点复发转移158例(53.9%),死亡223例(76.1%)。中位总生存时间21.2个月,1、3、5年生存率分别为71.7%、38.2%、10.6%。肿瘤分化程度、TNM分期、手术切缘、术中输血、肿瘤部位、血中碱性磷酸酶水平及复发是影响总生存时间的独立风险因素。结论肿瘤分化程度低、TNM分期晚、手术切缘有癌细胞浸润、术中输血、肿瘤位于肝外、血中碱性磷酸酶水平高于正常、肿瘤复发是影响胆管癌总生存的风险因素。

Objective To review and summarize the clinical data and survival information of patients with cholangiocarcinoma treated by surgery, and to explore the clinical and pathological features of cholangiocarcinoma, and the relationship between intraoperative and postoperative characteristics and prognosis. Methods We retrospectively analyzed the clinical data of 678 cholangiocarcinoma patients after operation in the PLA General Hospital from January 2004 to December 2010, including the follow-up results of 397 cases. Only 293 patients with surgical resection of cholangiocarcinoma and non-surgical reasons for death were analyzed using Cox proportional hazards model. All indicators were analyzed by univariate and multivariate analysis. Results The median follow-up time was 55.9 months. As of the end of follow-up, there were 158 cases of recurrence（53.9%） and 223 cases of death（76.1%）. The median overall survival time was 21.2 months, and 1-year, 3-year and 5-year survival rates were 71.7%, 38.2% and 10.6%, respectively. Tumor differentiation, TNM stage, surgical margin, intraoperative blood transfusion, tumor location, alkaline phosphatase levels in blood and recurrence were independent risk factors for overall survival time. Conclusions Low degree of tumor differentiation, advanced TNM stage, cancer invasion on the surgical margin, intraoperative blood transfusion, tumor located outside the liver, alkaline phosphatase levels in blood higher than normal, and cholangiocarcinoma tumor recurrence are risk factors for overall survival rate in patients with cholangiocarcinoma.