肝内胆管癌TACE治疗患者的预后因素分析

Analysis of prognostic factors in patients with intrahepatic cholangiocarcinoma after receiving transcatheter arterial chemoembolization

目的分析肝内胆管癌TACE后患者的预后因素。方法回顾性分析144例接受TACE治疗的原发性肝内胆管癌患者的临床资料,分析其术前各项指标与生存预后的关系。结果以外周血中性粒细胞淋巴细胞比值(NLR)=2.8作为最佳截断值,低NLR组患者的中位总生存时间(mOS)为27.0个月,高NLR组患者的mOS为10.8个月,低NLR组患者mOS明显长于高NLR组(1年生存率75.0%比43.5%,2年生存率51.1%比22.0%,P=0.004)。低NLR组患者的中位无进展生存时间(mPFS)为4.7个月,高NLR组患者的mPFS为2.5个月,两组患者之间的mPFS差异有统计学意义(P<0.05)。单因素分析显示区域淋巴结转移、肝外转移、ALP、GGT、AFP、CA19-9、NLR和血小板淋巴细胞比值(PLR)均是影响总体生存时间的预后因素,而NLR、CA19-9和血管侵犯是影响mPFS的预后因素。多因素分析提示,术前NLR是影响总体生存的独立预后因素。结论术前外周血NLR水平是影响肝内胆管癌患者行TACE治疗的独立预后因素,高NLR提示肝内胆管癌患者TACE的治疗效果较差。

Objective To analyze the prognostic factors in patients with intrahepatic cholangio carcinoma(ICC)after receiving transcatheter arterial chemoembolization(TACE).Methods The clinical data of 144 patients with primary ICC,who were treated with TACE,were retrospectively analyzed,and the relationships between the preoperative indexes and survival prognosis were analyzed.Results When the preoperative peripheral blood neutrophil-to-lymphocyte ratio(NLR)of 2.8 was used as the optimal cut-off value,the median overall survival(mOS)time in the low NLR group was 27.0 months,which was 10.8 months in the high NLR group.The m OS of the low NLR group was obviously higher than that of the high NLR group(one-year m OS rate:75.0%versus 43.5%,2-year mOS rates:51.1%versus 22.0%,P=0.004).The median progression-free survival(mPFS)time was 4.7 months in the low NLR,which was 2.5 months in the high NLR group,the difference in mPFS between the two groups was statistically significant(P<0.05).Univariate analysis showed that regional lymph node metastasis,extrahepatic metastasis,ALP,GGT,AFP,CA19-9,NLR and PLR were all prognostic factors for mOS time,while NLR,CA19-9 and vascular invasion were prognostic factors for mPFS.Multivariate analysis indicated that preoperative NLR was an independent prognostic factor for mOS time.Conclusion Preoperative peripheral blood NLR level is an independent prognostic factor in ICC patients treated with TACE.High NLR suggests a poor prognosis of ICC patients after receiving TACE.(J Intervent Radiol,2021,30:291-295).