远端胆管癌腹腔淋巴结转移的危险因素分析

Risk factors of lymph node metastasis in distal cholangiocarcinoma

目的分析远端胆管癌腹腔淋巴结转移的危险因素。方法回顾性分析首都医科大学附属北京朝阳医院2011年1月至2019年12月连续收治的123例远端胆管癌患者的临床资料,所有患者均接受胰十二指肠切除术。收集和分析患者病历资料并随访预后情况。生存率比较采用Log-rank检验,Logistic回归分析淋巴结转移的相关危险因素。结果123例患者均顺利完成手术,围手术期死亡6例,围手术期死亡率4.9%。术后总体中位生存时间为44.7个月,1、3、5年总体生存率分别为75.2%、41.9%、31.5%。淋巴结阳性患者51例,阳性率为41.5%,无淋巴结转移和有淋巴结转移患者的术后中位生存时间分别为55.5个月和27.5个月,1、3、5年总体生存率分别为83.0%、50.7%、42.5%和63.5%、19.0%、19.0%(P=0.000)。多因素分析显示,术前CA19-9(RR=7.064,95%CI:2.489~20.051)和门静脉系统侵犯(RR=4.610,95%CI:1.252~16.972)是远端胆管癌发生淋巴结转移的独立危险因素。结论淋巴结转移是影响远端胆管癌患者术后远期生存的重要原因,而CA19-9和门静脉系统侵犯是远端胆管癌发生淋巴结转移的独立危险因素。

Objective To analyze the risk factors of lymph node metastasis of distal cholangiocarcinoma.Methods We retrospectively analyzed the clinical data of 123 patients of distal cholangiocarcinoma in Beijing Chaoyang Hospital between Jan 2011 and Dec 2019.All patients underwent pancreatoduodenectomy.The prognosis was evaluated according to the follow-up results.The survival rate was compared by log-rank test.Logistic regression was used to analyze the risk factors for lymph node metastasis.Results One hundred and twenty-three patients successfully underwent the operations,6 patients died during the perioperative time.The overall 1-year,3-year and 5-year survival rates were 75.2%,41.9%and 31.5%.The median survival time was 44.7 months.Fifty-one patients had lymph node metastasis,and the rate of lymph node metastasis was 41.5%.The median survival time was 55.5 months and 27.5 months for patients without and with lymph node metastasis,respectively.Correspondingly,the survival rates of 1-year,3-year,5-year were 83.0%,50.7%,42.5%vs.63.5%,19.0%,19.0%(P=0.000).Multivariate analysis showed that preoperative CA19-9(RR=7.064,95%CI:2.489-20.051)and portal venous system invasion(RR=4.610,95%CI:1.252-16.972)were independent risk factors for lymph node metastasis.Conclusions Lymph node metastasis is an important factor affecting the long-term survival of patients with distal cholangiocarcinoma.Preoperative CA19-9 level and portal venous system invasion are independent risk factors for lymph node metastasis.