肝内胆管癌手术切除预后的相关因素研究

Surgical resection of intrahepatic cholangiocarcinoma: analysis of prognostic factors

目的:分析影响肝内胆管癌手术切除的预后相关因素,探讨根治性切除的临床意义。方法:回顾性分析2004年10月至2016年12月我院肝移植中心单一治疗组手术切除肝内胆管癌病人的临床资料和随访结果 ,分析影响病人预后的因素。结果:188例肝内胆管癌病人中,163例(86.7%)经手术切除。切除病人的1、3、5年生存率分别为64.5%、36.2%、23.6%。中位生存时间为26个月。术后发生并发症共37例(22.7%),其中死亡3例(1.8%),2例为肝功能衰竭,1例为感染性休克。多因素分析显示,手术切缘阳性(HR=5.95,P<0.001)、合并肝内胆管结石(HR=2.50,P=0.03)、淋巴结转移(HR=3.34,P=0.006)、肿瘤TNMⅢ~Ⅳ期(HR=3.11,P=0.048)、肿瘤低分化(HR=2.37,P=0.021)为肝内胆管癌独立的预后不良因素。结论:手术切缘、合并肝内胆管结石、淋巴结转移、肿瘤TNM分期、肿瘤分化程度为影响肝内胆管癌的独立预后因素。手术切除是肝内胆管癌的主要治疗手段,根治性切除可使病人长期生存。

Objective To analyze the prognostic factors of surgical resection of intrahepatic cholangiocarcinoma and the clinical effect of radical resection. Methods The patients undergoing resection for intrahepatic cholangiocarcinoma in our hospital from October 2004 to December 2016 were analyzed retrospectively with the prognosis factors. Results A total of 163 cases（86.7%） from 188 cases with intrahepatic cholangiocarcinoma were treated by resection. The 1-, 3-and 5-year survival rate of 163 cases after resection was 64.5%, 36.2% and 23.6% respectively. The median overall survival time was26 months. There were 37（22.7%） cases with postoperative complications. Two cases died of hepatic failure and 1 case septic shock with mortality（1.84%）. Multivariate analysis identified independent poor prognostic factors including positive surgical margin（HR=5.95, P0.001）, hepatolithiasis（HR=2.50, P=0.03）, lymph node metastasis（HR=3.34, P=0.006）, TNM stage Ⅲ-Ⅳ（HR=3.11, P=0.048） and lower tumor differentiation（HR=2.37, P=0.021）. Conclusions Surgical margin, hepatolithiasis, lymph node metastasis, TNM staging and tumor differentiation were related with prognosis of the patients with intrahepatic cholangiocarcinoma. Surgical treatment is an important strategy and radical resection offers the opportunity of long-term survival.