淋巴结转移数目及位置对肝内胆管癌根治术预后的影响

Impact of number and location of metastatic lymph nodes on prognosis in patients after resection for intrahepatic cholangiocarcinoma

目的探讨淋巴结转移数目(NMLN)及位置对肝内胆管癌根治性切除术后患者预后的影响。方法回顾性分析2010年1月至2020年12月于西安交通大学第一附属医院肝胆外科因肝内胆管癌行根治性切除及淋巴清扫术的105例患者的临床资料,其中男性49例,女性56例,年龄(58±10)岁。根据TNM分期(第8版)分为2组:N0期组(n=62)和N1期组(n=43)。依据NMLN分期将转移淋巴结为0、1~2、>3枚者分别分为3组:0期组(n=62)、1期组(n=24)、2期组(n=19)。将43例合并淋巴结转移患者依据淋巴结转移是否局限于第一站分为2组:第一站转移组(n=11)和非第一站转移组(n=32)。收集患者的一般资料、淋巴结清扫及病理情况、术后生存情况等临床资料。筛选肝内胆管癌根治术预后的危险因素。结果N0、N1期组淋巴结清扫或检出数目分别为6(3,8)和6(3,10)枚,两组间差异无统计学意义(Z=-1.10,P>0.05)。N0期组患者总体生存期优于N1期组(32.0比9.0个月,χ^(2)=23.99,P<0.001)。0期组、1期组和2期组患者中位生存时间分别为32.0、14.0和6.0个月,3组间总体生存期差异具有统计学意义(χ^(2)=32.18,P<0.001)。时间依赖的受试者工作特征曲线显示,NMLN分期较N分期具有更好的预后预测能力。第一站转移组和非第一站转移组的中位生存时间分别为18.0和7.0个月,两组患者总体生存期差异无统计学意义(χ^(2)=2.21,P>0.05)。多因素分析显示,肿瘤糖类抗原125>35.0 U/ml(HR=4.297,95%CI:2.418~7.634)、肝内胆管结石(HR=2.713,95%CI:1.499~4.911)、T4分期(HR=2.934,95%CI:1.478~5.825)、NMLN分期1期(HR=2.759,95%CI:1.500~5.077)、NMLN分期2期(HR=7.376,95%CI:3.553~15.312)为影响肝内胆管癌根治性切除术预后的独立危险因素(P<0.05)。结论淋巴结转移是肝内胆管癌根治术预后不良的重要危险因素,NMLN与患者预后具有一定相关性,而淋巴结转移位置与预后无关。

Objective To study the impact of number and location of metastatic lymph nodes on prognosis of patients after radical resection for intrahepatic cholangiocarcinoma(ICC).Methods A retrospective study was conducted on 105 patients who underwent radical resection and lymphadenectomy for ICC at the First Affiliated Hospital of Xi’an Jiaotong University from January 2010 to December 2020.There were 49 males and 56 females,with age of(58±10)years old.These patients were divided into 2 groups using the TNM staging(8th edition)into the N0 stage group(n=62)and N1 stage group(n=43).Using the NMLN staging,those with 0,1-2,and>3 number of metastatic lymph nodes(NMLN)were divided into 3 groups:the stage 0 group(n=62),stage 1 group(n=24),and stage 2 group(n=19).Of the 43 patients with lymph node metastasis,they were divided into 2 groups according to whether the lymph node metastasis was limited to the first lymph node station:the first station metastasis group(n=11)and the non-first station metastasis group(n=32).The general data,extent of lymph node dissection,pathological examinations,and postoperative survival outcomes of these patients were collected.Determination of risk factors for prognosis of ICC after radical resection was carried out.Results The median number of lymph node harvested,or the detection of N0 and N1 staging were 6(3,8)and 6(3,10),respectively.There were no significant differences between the two groups(Z=-1.10,P>0.05).Overall survival of patients in the N0 stage group was better than the N1 stage group(32.0 vs.9.0 months,χ^(2)=23.99,P<0.001).The median survival times of patients in the stage 0,stage 1 and stage 2 groups were 32.0,14.0 and 6.0 months,respectively.There was a significant difference in overall survival among the 3 groups(χ^(2)=32.18,P<0.001).The time-dependent receiver operating characteristic curves showed that NMLN staging had better prognostic predictive ability than the N staging.The median survival times of the first station metastasis group and the non-first station metastasis group were 18.0 and 7.0 months,respectively.There was no significant difference between the two groups(χ^(2)=2.21,P>0.05).Multivariate analysis showed that tumor carbohydrate antigen 125>35.0 U/ml(HR=4.297,95%CI:2.418-7.634),hepatolithiasis(HR=2.713,95%CI:1.499-4.911),T4 staging(HR=2.934,95%CI:1.478-5.825),NMLN stage 1(HR=2.759,95%CI:1.500-5.077)and NMLN stage 2(HR=7.376,95%CI:3.553-15.312)were independent risk factors affecting prognosis of ICC after radical resection(P<0.05).Conclusion Lymph node metastasis was an important poor prognostic risk factor after radical resection of intrahepatic cholangiocarcinoma.The prognosis of ICC patients was related to the NMLN,but it was not related to the location of metastatic lymph nodes.