肝内胆管囊腺癌临床病理特征及预后因素分析

Clinicopathological characteristics and prognostic factors of intrahepatic biliary cystadenocarcinoma

目的 分析肝内胆管囊腺癌的临床病理特点及治疗，探讨影响预后的相关因素。方法回顾性分析2000年1月～2014年4月46例经术后病理证实为肝内胆管囊腺癌患者的临床资料，并与58例囊腺瘤患者进行比较，采用kaplan-Meier单因素生存分析影响患者预后的相关因素。结果46例囊腺癌患者中男性15例，女性31例，平均年龄为57．0±10．7岁，主要临床表现为腹痛、腹部不适。囊腺癌患者的平均年龄明显高于囊腺瘤（57．0±10．7岁w44．3±15．3岁，P=-0．03），男性患者比例更高（15／46w8／58，P=0．02）。根据术前实验室及影像学检查难以对囊腺癌及囊腺瘤做出准确的鉴别诊断。囊腺癌患者的中位生存时间为56个月，1年，3年，5年生存率分别为：85．9％，65．2％，47．7％。性别（X2=4．05，P=0．04）、手术方式（X2=15．29，P=0．00）、肿瘤生长类型（X2=5．07，P=0．02）、肿瘤有无远处转移（X2=6．49，P=-0．01）是影响囊腺癌患者预后的重要危险因素。结论肝内胆管囊腺癌无特异性临床表现，完整性切除是患者取得良好预后的关键，对于男性及浸润型生长的肿瘤患者，术后仍需密切随访。

Objective To analyze the clinicopathological characteristics and the factors affecting the prognosis of intrahepatic biliary cystadenocarcinoma （IBC）. Methods Forty-six patients with histologically confirmed IBC from January 2000 to April, 2014 were included. The clinical characteristics of the patients with IBC were compared with those of 58 patients with intrahepatic biliary cystadenoma （IBCA）. Kaplan-Meier analysis was used to identify the factors affecting the prognosis of IBC. Results The 46 patients with IBC included 15 men and 31 women with a mean age of 57.0±10.5 years. Compared with the patients with IBCA, IBC patients had an older mean age （57.0±10.7 vs 44.3_＋15.3 years, P=0.03） and a greater proportion of male patients （15/46 vs 8/58, P=0.02）. The differential diagnosis between IBC and IBCA was difficult on the basis of preoperative laboratory and imaging findings. The median overall survival of IBC patients was 56 months with 1-, 3-, and 5-year survival rates of 85.9%, 65.2% and 47.7%, respectively. Gender, surgical approach, tumor growth pattern and distant metastasis were all significant prognostic factors for the overall survival of the patients. Conclusions IBC is a rare cystic lesion occurring primarily in middle-aged men. Complete resection is recommended for curative treatment and close follow-up is essential especially for male patients and patients with tumors exhibiting an invasive growth.