肝门部胆管癌不同分期方法的比较

A comparison of three different staging systems of hilar cholangiocarcinoma

目的 比较Bismuth-Corlette分型、AJCC-第7版TNM分期、以及MSKCC分期三种不同临床分期方法对肝门部胆管癌（hilar cholangiocarcinoma,HCC）患者手术切除率及预后的预测价值.方法 回顾性分析154例肝门部胆管癌临床与病理资料,采用三种不同分期方法进行分型/分期,分别与手术切除率及预后比较相关性.通过x2检验、Kaplan-Meier生存曲线来比较不同临床及病理因素和预后之间的关系.结果 Bismuth-Corlette分型、TNM分期Ⅰ、Ⅱ、Ⅲ、Ⅳ型（期）预测手术切除率差异无统计学意义;MSKCC分期T1、T2、T3期手术切除率依次为68.6％,44.8％,19.2％,随着MSKCC分期的增高,手术切除率呈现明显的下降（x2=20.03,P=0.000）.Bismuth-Corlette分型的生存函数曲线存在多处交叉,而TNM分期和MSKCC分期的生存曲线呈现较好的平行下降.肿瘤分化程度、淋巴结受累情况、有无远处转移、手术切缘是否阴性、TNM分期和MSKCC分期等级情况与预后相关.结论 MSKCC分期比Bismuth-Corlette分型和TNM分期更准确预测手术切除率,并且MSKCC分期和TNM分期在预测患者术后生存时间上优于Bismuth-Corlette分型.肿瘤分化程度、淋巴结受累情况、有无远处转移、手术切缘是否是阴性、TNM分期和MSKCC分期等级情况与患者的预后相关.

Objective To compare the value among three hilar cholangiocarcinoma （HCC） staging systems,Bismuth-Corlette classification,TNM staging system and MSKCC classification,in predicting the resection rate and prognosis of HCC patients.Methods The clinical and histopathological data of 154 HCC cases were analyzed retrospectively.Three different staging methods were performed respectively to analyze the correlations with respectability and survival.Chi-square test and Kaplan-Meier analysis were applied to find clinical and histopathological factors related to prognosis.Results There was no significant difference in resectability between Bismuth-Corlette classification or TNM stage Ⅰ,Ⅱ,Ⅲ and Ⅳ.The resection rates of MSKCC T1,T2 and T3 were 68.6％,44.8％,19.2％respectively （x2 =20.03,P =0.000）.With higher T stage,resection rate obviously declined.The survival predicted by TNM staging and MSKCC classification was better than Bismuth-Corlette classification.Tumor differentiation,LN involvement,distant metastasis,margin status,TNM stage and MSKCC classification were significantly correlated with survival.Conclusions The MSKCC classification predicted resectability better than Bismuth-Corlette classification and TNM staging system,while both MSKCC classification and TNM staging system predicted survival better than Bismuth-Corlette classification.Clinical and histopathological factors such as tumor differentiation,LN involvement,metastasis,margin status,TNM staging,MSKCC classification were correlated with survival.