术后经导管动脉化疗栓塞对肝内胆管细胞癌患者远期预后的影响

Effect of post-operative transcatheter arterial chemoembolization on long-term prognosis of patients with intrahepatic cholangiocarcinoma

目的评估术后经导管动脉化疗栓塞(pTACE)对肝内胆管细胞癌(ICC)患者远期预后的影响,并鉴别适合进行术后pTACE辅助治疗的ICC患者。方法纳入2010年1月至2011年12月在第二军医大学东方肝胆外科医院接受根治性切除术治疗的114例ICC患者,通过单因素和多因素分析确定总生存期(OS)和无复发生存期(RFS)的独立危险因素。有1项及以上复发危险因素的患者被定义为高风险组(n=73),没有复发危险因素的被定义为低风险组(n=41),比较pTACE对这两组患者预后的影响。结果多因素分析结果显示多发肿瘤(HR=3.515,95%CI:2.083~5.932,P<0.001)、肿瘤最大径>5cm(HR=2.050,95%CI:1.309~3.210,P=0.002)、微血管侵犯(HR=2.287,95%CI:1.104~4.736,P=0.026)、手术切缘阳性(HR=5.089,95%CI:2.055~12.600,P<0.001)和淋巴结转移(HR=2.880,95%CI:1.579~5.251,P=0.001)是OS的独立危险因素;多发肿瘤(HR=2.752,95%CI:1.619~4.678,P<0.001)、肿瘤最大径>5cm(HR=2.010,95%CI:1.298~3.113,P=0.002)和微血管侵犯(HR=3.857,95%CI:1.856~8.013,P<0.001)是RFS的独立危险因素。虽然pTACE不是OS或RFS的独立预后因素,但pTACE可以改善高风险组患者的OS和RFS(P<0.05)。结论具有术后复发危险因素的ICC患者可从pTACE中获益,应该建议接受pTACE治疗。

Objective To evaluate the effect of postoperative transcatheter arterial chemoembolization(pTACE)on the long-term prognosis of patients with intrahepatic cholangiocarcinoma(ICC),and to identify the proper ICC patients for the adjuvant therapy.Methods A total of 114 ICC patients were included,who received radical resection at the Eastern Hepatobiliary Surgery Hospital of Second Military Medical University from Jan.2010 to Dec.2011.Univariate and multivariate analyses were performed to determine the independent risk factors of overall survival(OS)and recurrence-free survival(RFS).Patients with one or more risk factors for relapse were included in the high-risk group(n=73)and those without risk factors of relapse were included in the low-risk group(n=41).The effect of pTACE on the prognosis of patients in the two groups was compared.Results Multivariate analysis results showed that multiple tumor(HR=3.515,95%CI2.083-5.932,P<0.001),tumor maximum diameter>5 cm(HR=2.050,95%CI1.309-3.210,P=0.002),microvascular invasion(HR=2.287,95%CI1.104-4.736,P=0.026),positive surgical margin(HR=5.089,95%CI2.055-12.600,P<0.001)and lymph node metastasis(HR=2.880,95%CI1.579-5.251,P=0.001)were the independent risk factors of OS;and multiple tumor(HR=2.752,95%CI 1.619-4.678,P<0.001),tumor maximum diameter>5 cm(HR=2.010,95%CI:1.298-3.113,P=0.002)and microvascular invasion(HR=3.857,95%CI:1.856-8.013,P<0.001)were the independent risk factors of RFS.pTACE was not an independent prognostic factor of OS or RFS,but pTACE significantly improved OS and RFS of patients in the high-risk group compared with the low-risk group(P< 0.05).Conclusion ICC patients with independent risk factors of relapse after surgery can benefit from pTACE,suggesting that they should receive pTACE therapy.