术前血清CA19-9水平对乙肝相关性肝内胆管细胞癌根治术后预后影响分析

Efffect of preoperative serum level of CA19-9 on the prognosis of HBV-associated intrahepatic cholangiocarcinoma patients after curative hepatectomy: a retrospective cohort study

目的评估术前血清糖类抗原19-9(carbohydrate antigen19-9,CA19-9)水平对乙肝相关性肝内胆管细胞癌(hepatitis B virus-associated intrahepatic cholangiocarcinoma,HBV-ICC)根治术后预后的影响。方法连续收集我院2007年1月至2009年10月行手术根治治疗的143例HBV-ICC患者的临床及随访资料。根据术前CA19-9水平,将患者分为CA19-9升高组(>37 U/mL)与CA19-9正常组(≤37 U/mL),并借助软件SPSS20.0比较两组的临床病理学和预后差异。结果 CA19-9升高组临床症状阳性率,ALT、碱性磷酸酶(alkaline phosphatase,ALP)、谷胺酰转肽酶(γ-glutamyltransferase,γ-GT)等术前水平明显高于CA19-9正常组(P<0.05),而且,CA19-9升高组更易出现淋巴结转移及微血管侵犯(P<0.05)。CA19-9升高组与CA19-9正常组1、3和5年的总体生存率分别为82%vs 58%,65%vs 28%和52%vs 20%(P<0.001)。CA19-9升高组与CA19-9正常组1、3和5年的无瘤生存率分别为69%vs 37%,51%vs 20%和45%vs 15%(P<0.001)。结论术前CA19-9水平升高是HBV-ICC患者根治性肝切除术后预后差的危险因素。

Objective To evaluate the prognostic effect of preoperative serum level of CA19-9 on hepatitis B virus-associated intrahepatic cholangiocarcinoma（HBV-ICC） patients after curative hepatectomy. Methods The clinicopathological and follow-up data of 143 HBV-ICC patients underwent curative hepatectomy in our hospital from Jan. 2007 to Dec. 2009 were collected consecutively. According to preoperative serum CA19-9 levels, these patients were divided into the elevated group（CA19-937 U/m L） and the normal group（CA19-9 ≤37 U/m L）, then clinicopathlogical and prognostic differences is between two groups were analyzed by SPSS version 20.0. Results Compared with the normal group, the elevated group tended to have a higher positive symptom rate and an elevated level of ALT, ALP and γ-GT（P0.05）. Lymph node metastasis and microvascular invasion were more prevalent in elevated group than that in the normal group. The 1-, 3- and 5-year overall survival rates for the elevated group and the normal group were 82% vs 58%, 65% vs 28% and 52% vs 20%（P〈0.001）, respectively. The 1-, 3- and 5-year recurrence free survival rates for the elevated group and the normal group were 82% vs 58%, 65% vs 28% and 52% vs 20%（P〈0.001）. Conclusion Elevated preoperative serum CA19-9 level is a risk factor for poor prognosis of HBV-ICC patients after curative hepatectomy.