肝内胆管癌根治性切除术后生存因素分析及列线图的建立

Analysis of prognostic factors after radical resection of intrahepatic cholangiocarcinoma and establishment of a nomogram

目的探讨肝内胆管癌(ICC)根治性切除术后生存影响因素,个体化建立列线图预测术后总生存时间。方法搜集2009年7月至2017年10月于我院行根治性手术的79例ICC患者的临床及病理资料,Kaplan-Meier和Cox回归模型用于分析临床及病理特征对术后总体生存率和无复发生存率的影响,通过R软件(版本号4.0.1)建立生存列线图,并使用一致性指数、校准曲线及ROC曲线下面积(AUC)验证列线图的预测效能。结果79例患者术后第1、2、3年累积无复发生存率分别为43.0%、26.6%、20.3%,中位生存期为15个月,79例患者术后第1、2、3年累积总生存率分别为63.3%、41.8%、27.8%。多因素分析显示CA19-9、脉管癌栓、肿瘤数目是影响患者生存的独立危险因素。CA19-9、肿瘤数目、病理分化程度是影响复发的独立危险因素。一致性指数为0.723(95%CI:0.66~0.79),第1、2、3年生存率的AUC分别为0.78(95%CI:0.68~0.89)、0.85(95%CI:0.77~0.93)、0.77(95%CI:0.67~0.87)。结论ICC预后较差,早期症状不典型,术后生存率低,CA19-9、肿瘤数目是影响生存和复发的共同独立危险因素。经内部验证的列线图对术后患者的生存率有较好的预测能力。

Objective To explore the prognostic factors after radical resection of intrahepatic cholangiocarcinoma(ICC)and to establish a nomogram to predict postoperative overall survival.Methods The clinicopathological data of 79 ICC patients who underwent radical resection in our hospital during Jul.2009 and Oct.2017 were collected.The impacts of clinicopathological characteristics on overall survival and recurrence-free survival were analyzed with Kaplan-Meier and Cox regression models.A survival nomogram was established with R software(version 4.0.1),and the predictive performance of the nomogram was verified with C-index,calibration curve and area under ROC curve(AUC).Results The 1-year,2-year,and 3-year cumulative recurrence-free survival rates were 43.0%,26.6%and 20.3%,respectively.The median survival time was 15 months,and the 1-year,2-year,and 3-year cumulative overall survival rates were 63.3%,41.8%and 27.8%,respectively.Multivariate analysis demonstrated that CA19-9,lymphovascular invasion and multiple tumors were independent risk factors of overall survival.CA19-9,multiple tumors and differentiation of tumors were independent risk factors of recurrence.The C-index was 0.723(95%CI:0.66-0.79),and the AUC of 1-year,2-year,and 3-year survival rates were 0.78(95%CI:0.68-0.89),0.85(95%CI:0.77-0.93),and 0.77(95%CI:0.67-0.87),respectively.Conclusion ICC has a poor prognosis and low postoperative survival rate.The early symptoms are atypical.CA19-9 and multiple tumors are independent risk factors for both survival and recurrence.The internally validated nomogram can predict the survival rates.