肝内胆管细胞癌外科治疗疗效分析

Survival outcomes of patients with intrahepatic cholangiocarcinoma undergoing surgical resection

目的探讨手术切除治疗肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)的临床疗效及分析影响预后的危险因素。方法回顾性分析2015年1月1日至2021年4月30日于安徽医科大学第一附属医院普外科接受手术切除的ICC患者的临床资料。结果67例获得完整随访,最终纳入本研究中。截止至2022年4月30日,中位随访时间14(1~60)个月,53例(79.1%)肿瘤复发,52例(77.6%)死亡,其中49例(73.1%)死于肿瘤复发,全组1、2、3年累积的无瘤和总体生存率分别为35.6%、19.6%、16.8%和53.7%、32.4%、20.8%。无微血管侵犯组总体生存率显著优于有微血管侵犯组(χ^(2)=5.916,P=0.015)。CA19-9≥1000 U/ml是影响ICC术后无瘤生存时间的独立危险因素。CA19-9≥1000 U/ml、术中失血量≥600 ml、微血管侵犯和肿瘤复发是影响ICC术后总体生存时间的独立危险因素。结论单发ICC肿瘤,当肿瘤直径≤5 cm且考虑无微血管侵犯时,可积极推荐手术切除,能够取得较为满意的手术效果。

Objective To investigate the clinical outcomes of patients with intrahepatic cholangiocarcinoma(ICC)undergoing surgical resection.Methods Patients who undergoing radical surgical resection for ICC from Jan 2015 to Apr 2021 at the Department of General Surgery,the First Affiliated Hospital of Anhui Medical University were included in this retrospective cohort study.Results There were 67 patients in the final analysis,The median follow-up duration was 14 months(range:1-60 months).Firty three patients(79.1%)had tumor recurrence,52 patients(77.6%)died,Among them,49 patients(73.1%)died from tumor recurrence.The 1-、2-、and 3-year accumulated disease-free and overall survival rate were 35.6%,19.6%,16.8%and 53.7%,32.4%,20.8%.respectively.The overall survival rate of the group without microvascular invasion was significantly better than those of the group with microvascular invasion(χ^(2)=5.916,P=0.015).CA19-9≥1000 U/ml was the only independent risk factor for the disease-free survival.CA19-9≥1000 U/ml、blood loss≥600 ml、microvascular invasion and tumor recurrence were the independent risk factors for the overall survival.Conclusion For ICC patients with single tumor,when the tumor diameter is less than 5 cm and has no microvascular invasion,surgical resection is recommended,and a satisfactory prognosis could be achieved.