影响肝内胆管细胞癌预后高危因素的临床回顾分析

Impact of surgical treatment and poor prognostic factors for patients with intrahepatic cholangiocarcinonm： a retrospective report of 103 patients

目的探究影响肝内胆管细胞癌（ICC）手术预后的可能因素，为进一步改善ICC的预后提供借鉴。方法对2009年1月至2011年12月期间103例行根治性手术切除的ICC病人临床病理特征进行生存率、无瘤生存率的单因素分析，并通过Cox多因素分析得到有独立意义的预后指标。结果103例ICC病人术后1年、3年生存率为77．70％、45．76％，无瘤生存率为67．65％、40．75％。单因素分析提示性别、肿瘤数目、肿瘤大小、脉管侵犯、淋巴结转移：术前CEA影响病人的无瘤生存率及生存率。Cox多因素分析提示脉管侵犯、淋巴结转移和术前癌胚抗原（CEA）是影响ICC病人生存的独立因素；肿瘤大小、神经束侵犯、脉管侵犯和术前CEA是影响ICC病人无瘤生存的独立因素。结论ICC的局部侵犯和淋巴结转移是影响ICC病人预后的重要因素，如何进一步规范ICC的治疗，包括术前评估、术中手术方式（是否需常规的淋巴结清扫）、术后辅助方案的制定，需要多中心随机对照研究结果的支持。

Objective To provide rationales for improved outcomes of intrahepatic cholangiocarcinoma （ICC） by examining its prognostic factors after resection. Methods A total of 103 patients undergoing surgery for ICC with a curative intent between 2009 and 2011 were recruited. Their clinicopathological data associated with overall survival （OS） and disease free survival （DFS） were evaluated with univariate and multivariate analysis. Results The 1 and 3-year rates of OS were 77. 7% and 45. 8%. As to DFS, it was 67. 65% and 40. 75% respectively. Factors associated with adverse prog- nosis included gender, tumor number, tumor size, lymphovascular invasion, lymph node metastasis （LNM） and preoperative CEA according to univariate analysis. And multivariate analysis indicated that lymphovascular invasion, LNM and CEA influenced OS independently. And tumor size, perineu- ral invasion, lymphovaseular invasion and CEA could predict higher risks of recurrence. Conclusions Local invasion and LNM of ICC are important prognostic factors. Whether or not standards of care for ICC include preoperative examination, regular lymphadenectomy and adjuvant therapy requires the supports of randomized multi-center trials.