大体分型对肝内胆管细胞癌预后的影响

Impact of morphological classification of intrahepatic cholangiocarcinoma on long-term prognosis

目的探讨肝内胆管细胞癌(ICC)大体分型与预后的关系。方法回顾性分析自2011年1月至2019年5月宁波市医疗中心李惠利医院收治并行手术达到R0切除的125例ICC患者的临床病理资料。其中男性67例,女性58例,年龄26.0~82.0(63.5±9.5)岁。根据手术切除大体标本分为肿块型、管周浸润型和混合型,比较不同大体分型ICC患者术后生存率和无复发生存时间,并分析影响ICC患者术后预后的危险因素。结果根据纳入排除标准,收集的125例患者中排除16例资料缺失及其他死亡病例,且鉴于混合型例数少,进行对照研究误差大,暂不纳入对照研究。最终纳入肿块组62例,管周浸润组42例。肿块组患者男32例,女30例,年龄(63.1±9.1)岁;管周浸润组男22例,女20例,年龄(64.1±10.2)岁。肿块组患者术后1、3、5年生存率分别为78.1%、33.2%、18.9%,中位生存时间为25个月;管周浸润组患者术后1、3、5年生存率分别为63.3%、8.3%、6.1%,中位生存时间为15个月,差异有统计学意义(P<0.05)。肿块组和管周浸润组的中位无复发生存时间分别为18个月和11个月,差异有统计学意义(P<0.05)。单因素和多因素分析显示,TNM分期Ⅲ~Ⅳ期(HR=2.966,95%CI:1.549~5.679)和管周浸润型(HR=2.403,95%CI:1.236~4.670)是影响ICC患者术后生存的独立危险因素;TNM分期Ⅲ~Ⅳ期(HR=2.466,95%CI:1.325~4.589)、肿瘤低分化(HR=0.528,95%CI:0.299~0.934)、管周浸润型(HR=2.432,95%CI:1.295~4.565)是影响ICC患者术后无复发生存的独立危险因素(均P<0.05)。结论大体分型是影响ICC患者预后的独立危险因素。相对于肿块型,管周浸润型预后更差。

Objective To study the relationship between morphologic classification and prognosis of patients with intrahepatic cholangiocarcinoma(ICC).Methods The clinicopathologic data of 125 ICC patients who underwent R0 resection at the Ningbo Medical Center Li Huili Hospital from January 2011 to May 2019 were retrospectively analyzed.This cohort consisted of 67 males and 58 females,aged 26.0 to 82.0(63.5±9.5)years old.Based on the resected specimens,the patients were divided into the mass forming type,periductal infiltrating type and mixed type.The survival rates and recurrence-free survival outcomes of the patients among the three types were compared,and the risk factors that influenced prognosis were analyzed.Results Using the predetermined inclusion and exclusion criteria,16 patients with missing data and other causes of death were excluded from the initial 125 patients.Also,as the number of the mixed type was small,these patients were excluded.Finally 62 patients in the mass forming type and 42 patients in the periductal infiltrating type were analyzed.In the mass forming group,there were 32 males and 30 females,aged(63.1±9.1)years.In the perivascular infiltration group,there were 22 males and 20 females,aged(64.1±10.2)years.The 1-,3-,5-year survival rates of the mass forming group were 78.1%,33.2%,18.9%(median survival 25 months).The 1-,3-,5-year survival rates of the periductal infiltrating type were 63.3%,8.3%,6.1%(median survival 15 months).There were statistically significant differences between the two groups(P<0.05).The median recurrence-free survival for the mass forming and the periductal infiltrating groups were 18 and 11 months,respectively,with a statistically significant differences between them(P<0.05).Univariate and multivariate analysis showed that TNM stagingⅢ~Ⅳ(HR=2.966,95%CI:1.549-5.679)and periductal infiltrating type(HR=2.403,95%CI:1.236-4.670)were independent risk factors for survival of these patients after operations.TNM stagingⅢ~Ⅳ(HR=2.466,95%CI:1.325-4.589),low grade differentiation(HR=0.528,95%CI:0.299-0.934)and periductal infiltrating type(HR=2.432,95%CI:1.295-4.565)were independent risk factors for relapse-free survival of these patients(P<0.05).Conclusions Morphological classification was found to be an independent risk factor for prognosis of ICC patients in this study,with significantly worse long-term prognosis when compared with the mass forming type.