混合型肝癌预后评价及相关影响因素分析

Analysis of prognosis and related risk factors of combined hepatocellular carcinoma and cholangiocarcinoma

目的评价混合型肝癌(cHCC-CC)病人的预后并分析与预后相关的影响因素。方法回顾性分析2015年9月至2019年9月海军军医大学东方肝胆外科医院收治的54例cHCC-CC病人的临床资料。随访观察3年,采用Kaplan-Meier法进行生存分析,并分析cHCC-CC病人预后的影响因素。结果 54例cHCC-CC病人术后1、2、3年总体生存率为84.7%、61.1%、47.0%,无病生存率为50.8%、46.9%、26.4%,中位生存期(OS)、无病生存期(DFS)分别为29.1、17.7个月。单因素分析显示,肿瘤最大径≥5 cm、微血管侵犯、淋巴结转移为OS和DFS的影响因素。Cox多因素分析显示,肿瘤最大径≥5 cm(P=0.035)、微血管侵犯(P=0.023)、淋巴结转移(P=0.041)为OS的独立危险因素;微血管侵犯(P=0.007)、淋巴结转移(P=0.024)是DFS的独立危险因素。结论 cHCC-CC预后较差,兼有肝细胞癌及胆管细胞癌的特点,肿瘤直径≥5 cm、微血管侵犯及淋巴结转移影响病人预后生存,建议据此选择个体化治疗方案。

Objective To observe the prognosis of patients with combined hepatocellular carcinoma and cholangiocarcinoma(cHCC-CC) and analyse the risk factors.Methods Clinical data of 54 cHCC-CC patients in Eastern Hepatobiliary Surgery Hospital of Naval Medical University from September 2015 to September 2019 were retrospectively analyzed.Kaplan-Meier survival analysis was performed with SPSS26.0 software,and survival curves were drawn. Univariate analysis and Cox multivariate analysis were performed.Follow-up investigations were conducted for 3 years after discharge from the hospital.The effect of potential risk factors on the prognosis of patients with cHCC-CC was analyzed according to the results.Results The overall survival at 1,2 and 3 years after surgery was 84.7%,61.1%,47.0%,respectively,whereas the disease-free survival at 1,2 and 3 years after surgery was 50.8%,46.9%,26.4%,respectively.Median survival and median recurrence time were 29.1 and 17.7 months,respectively.Univariate analysis showed that maximum tumor diameter ≥5 cm,microvascular invasion and lymph node metastasis were influencing factors of OS and DFS.Cox multivariate analysis showed that maximum tumor size ≥5 cm(P=0.035),microvascular invasion(P=0.023) and lymph node metastasis(P=0.041) were independent risk factors of OS.Microvascular invasion(P=0.007) and lymph node metastasis(P=0.024) were independent risk factors of DFS.Conclusion cHCC-CC is a highly malignant disease,harboring the characteristics of hepatocellular carcinoma and cholangiocarcinoma.This study demonstrated that maximum tumor diameter≥5 cm,presence of microvascular invasion and lymph node metastasis will affect the prognosis of these patients.Therefore,Individualized treatment should be carried out according to these specific treatment indicators.