术前炎性指标联合肿瘤标志物对肝内胆管癌淋巴结转移的预测价值

Preoperative inflammatory indicators combined with tumor biomarkers for predicting the lymph node metastasis of intrahepatic cholangiocarcinoma

目的探讨术前炎性指标联合肿瘤标志物对肝内胆管癌淋巴结转移的预测价值。方法回顾性分析2010年1月~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例患者的临床病理资料,采用ROC曲线确定不同炎性指标的最佳截断值。各组间比较采用χ^(2)检验,生存分析采用Kaplan-Meier法和Log-rank检验。结果本研究纳入的105例患者,N0期及N1期患者分别为62例、43例,N0期及N1期患者中位生存时间分别为32个月、9.0个月;N0期及N1期患者1、3年总体生存率分别为79.2%、41.2%及36.4%、12.0%。评估不同术前炎性指标及肿瘤标志物对肝内胆管癌淋巴结转移预测价值发现,系统免疫炎症指数(SII)及CA19-9对淋巴结转移的预测价值最佳(ROC曲线下面积:0.662、0.707,95%CI:0.553~0.770、0.606~0.808,P<0.05)。N1患者中,SII>752.87及CA19-9>39.0 U/mL比例明显高于N0患者(χ^(2)=6.641、6.244,P<0.05)。生存分析显示,SII、CA19-9是影响ICC术后预后的危险因素之一(HR=1.881、2.176,95%CI:1.133~3.123、1.293~3.663,P<0.05)。通过联合炎症指标及肿瘤标志物预测淋巴结转移,结果显示SII+CA19-9联合诊断淋巴结转移效能最佳,ROC曲线下面积为0.782(95%CI:0.692~0.872,P<0.001)。进一步对联合SII+CA19-9后分组,各组患者生存差异具有统计学意义(P=0.001)。结论术前炎性指标SII联合CA19-9对肝内胆管癌淋巴结转移具有良好诊断价值,且对术后预后具有较好的评估能力。

Objective To explore the predictive value of preoperative inflammatory indicators combined with tumor biomarkers for lymph node metastasis of intrahepatic cholangiocarcinoma(ICC).Methods A total of 105 patients who underwent radical resection and lymph node dissection for ICC in the Department of Hepatobiliary Surgery of the First Affiliated Hospital of Xi’an Jiaotong University from January 2010 to December 2020 were retrospectively analyzed.Among them,49(43.8%)patients were male and 56(56.2%)patients were female,aged from 29 to 81 years with an average of(57.85±10.29)years old.ROC curve was conducted to determine the best cut-off values of each preoperative inflammatory indicator.The χ^(2) test was conducted for comparison between groups,the Kaplan-Meier method and Log-rank test were conducted for univariate analysis.Results All 105 patients included in this study,there were 62 patients N0 stage and 43 patients with N1 stage.The median survival time of N0 stage and N1 stage patients was 32 months and 9.0 months,respectively;the overall survival rates of 1 and 3 years were 79.2%,41.2%and 36.4%,12.0%for patients with N0 and N1 stages,respectively.By evaluating the predictive value of different preoperative inflammatory indicators and tumor biomarkers for lymph node metastasis of ICC,the results that the systemic immune-inflammation index(SII)and the CA19-9 had best predictive ability on lymph node metastasis(area under the ROC curves:0.662,0.707,95%CI:0.553~0.770,0.606~0.808,P<0.05).In N1 stage patients,the ratio of SII>752.87 and CA19-9>39.0U/mL was significantly higher than that of N0 patients(χ^(2)=6.641,6.244,P<0.05).Survival analysis showed that SII and CA19-9 were the risk factors affecting the prognosis for ICC(HR=1.881,2.176,95%CI:1.133~3.123,1.293~3.663,P<0.05).The combination of inflammation indicators and tumor biomarkers was used to predict lymph node metastasis,and the results showed that the combination of SII+CA19-9 had the best predictive ability for lymph node metastasis,and the area under the ROC curve was 0.782(95%CI:0.692~0.872,P<0.001).After further grouping the combined SII+CA19-9,the survival difference of patients in each group was statistically significant(P=0.001).Conclusion The preoperative inflammatory indicator SII combined with CA19-9 has good diagnostic value for lymph node metastasis of intrahepatic cholangiocarcinoma,and has a good ability to evaluate postoperative prognosis.