远端胆管癌手术预后评价及相关危险因素分析

Prognosis and related risk factors of distal cholangiocarcinoma after surgical treatment

目的评价远端胆管癌患者行手术切除的远期疗效,并分析影响其预后的相关危险因素。方法回顾性分析首都医科大学附属北京朝阳医院2011年1月—2019年12月收治的连续123例远端胆管癌患者的临床资料,其中男性72例,女性51例,年龄(64.9±9.2)岁,年龄范围29~84岁。所有患者均接受胰十二指肠切除术。观察指标:(1)围手术期情况;(2)随访情况;(3)影响远端胆管癌术后远期生存的危险因素分析。采用门诊复查及电话随访相结合的方式进行随访,了解患者术后生存情况,随访截止日期为2020年3月。符合正态分布的计量资料采用均数±标准差(Mean±SD)表示,非正态分布的计量资料采用M(P25,P75)表示。计数资料用例数和百分数(%)表示。应用Kaplan-Meier法计算并绘制生存曲线,生存率的比较采用Log-rank检验。多因素分析采用Cox比例风险模型。结果(1)围手术期情况:本组123例患者均顺利完成手术,围手术期死亡6例,围手术期病死率4.9%。术后发生并发症患者34例,并发症发生率为27.6%。(2)随访情况:121例患者获得随访,随访率为98.4%,中位随访时间41.0个月。患者总体术后中位生存时间为42.7个月,术后1、2、3、5年总体生存率分别为71.8%、50.5%、35.5%、30.2%。(3)影响远端胆管癌术后远期生存的危险因素分析:多因素分析显示,术前CA19-9(RR=1.470,95%CI:1.028~2.101)、门静脉系统侵犯(RR=2.020,95%CI:1.012~4.035)和肿瘤分化程度(RR=1.735,95%CI:1.195~2.520)是影响远端胆管癌术后远期生存的独立危险因素。结论根治性胰十二指肠切除术是远端胆管癌患者的最佳治疗方式。术前CA19-9水平、门静脉系统侵犯和肿瘤分化程度是影响患者远期预后的独立危险因素。

Objective To evaluate the prognosis and related risk factors of distal cholangiocarcinoma after surgical treatment.Methods The clinical data of 123 patients of distal cholangiocarcinoma in Beijing Chaoyang Hospital between January 2011 and December 2019 were retrospectively analyzed,which including 72 males and 51 females,the average age was(64.9±9.2)years(range from 29 to 84 years).All patients underwent pancreatoduodenectomy.The observation measures contains:(1)Perioperative outcomes;(2)Follow-up outcomes;(3)Risk factors for long-term survival of distal cholangiocarcinoma.Follow-up was carried out to understand the long-term survival of patients,and follow-up method contains the outpatient reexamination and telephone.The deadline of follow-up date was March 2020.The normal distribution data were expressed by(Mean±SD),and the non-normal distribution data were expressed by M(P25,P75).Count data were expressed by cases and percentage.Kaplan-Meier method was used to calculate and draw the survival curve.Log-rank test was used to compare the survival rate.Cox proportional risk model was used in multivariate factor analysis.Results(1)Perioperative outcomes:In our research,all of 123 patients were successfully completed the operations,and 6 patients dead during the perioperative.(2)Follow-up outcomes:The incidence of postoperative complications was 27.6%(34/123).One hundred and twenty-one patients were followed up,the follow-up rate was 98.4%,and the median follow-up time was 41.0 months.The overall 1-year,2-year,3-year and 5-year survival rates were 71.8%,50.5%,35.5%and 30.2%.And the median survival time was 42.7 months.(3)Risk factors for long-term survival of distal cholangiocarcinoma:Multivariate analysis showed that preoperative CA19-9(RR=1.470,95%CI:1.028-2.101),portal venous system invasion(RR=2.020,95%CI:1.012-4.035)and tumor differentiation(RR=1.735,95%CI:1.195-2.520)were independent risk factors for the prognosis.Conclusions Radical pancreatoduodenectomy is the best treatment for distal cholangiocarcinoma.Preoperative CA19-9 level,portal venous system invasion and tumor differentiation are independent risk factors for the prognosis.