影响肝门部胆管癌术后生存质量的多因素分析

Multivariate analysis of survival risk factors in patients with portal hilar cholangiocarcinom

目的综合分析肝门部胆管癌的临床分型、病理学特征及不同手术方式,探讨影响肝门部胆管癌术后预后的危险因素分析。方法回顾性分析2006年6月至2013年3月武汉大学人民医院收治的76例肝门部胆管癌病人的临床资料。采用COX生存风险回归模型分析影响病人预后的危险因素。Kaplan-Meier法分析病人中位生存时间。结果肝门部胆管癌术后病人1、2、3年生存率分别为88%、72%和41%,中位生存时间为21个月。COX回归模型分析显示肿瘤分型、手术方式、淋巴结转移和癌抗原(CA)199水平是影响肝门部胆管癌预后的独立危险因素。结论肝门部胆管癌的预后与肿瘤分型、手术方式、CA199水平和淋巴结转移等密切相关。扩大淋巴结清扫及根治性手术方式是提高病人生存率的关键。

Objective To analyze the clinical typing and pathologic characteristics of hilarcholangiocareinoma （HC） and surgical strategies on hilar cholangiocarcinoma （HC）, and to investigate the risk factors influencing survival of patients with porta hepatic cholangiocarcinoma excised. Methods The clinical data were retrospectively analyzed in 76 cases of HC admitted into our hospital from Jun. 2006 to Mar. 2013. Suivival risk factors were analyzed with COX regression model, and survival time was analyzed with Kaplan-Meier test. Results Of the HC patients, the mean survival time was 21 months, the 1-, 2-and 3-year survival rate was 88%, 72% and 41% respectively. The multivari- able analysis revealed that the clinical typing of tumor, operative approach, lymph node metastasis and CA19-9 levels were independent prognostic factors of survival for HC （P〈0. 05）. Conclusions The prognosis of HC correlates with the clinical typing of tumor, operative approach, CA19-9 levels, and lymph node metastasis. Curative resection including extended radical resection of lymph nodes carries the best effects that can prolong survive.