肝内胆管细胞癌淋巴结清扫患者生存获益的术前临床病理特征

Preoperative clinicopathological features of patients obtaining survival benefit from lymph node dissection in intrahepatic cholangiocarcinoma resection

目的探讨肝内胆管细胞癌(ICC)切除术中行淋巴结清扫患者生存获益的术前临床病理特征。方法回顾性分析2010年1月至2018年12月在中国8家三甲医院行ICC根治性切除术的415例患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男225例,女190例;年龄27~83岁,中位年龄59岁。根据患者术中是否行淋巴清扫术,将患者分为清扫组和未清扫组。使用倾向性评分匹配法(PSM)对清扫组和未清扫组的组间差异进行均衡。生存分析采用Kaplan-Meier法和Log-rank检验,分析清扫组生存获益的术前临床病理特征。结果PSM前,清扫组283例,未清扫组132例。经1:1PSM后,共筛选出228例,两组各114例。清扫组和未清扫组中位生存期分别为35.4、25.0个月,清扫组总体生存率明显高于未清扫组(χ^(2)=5.404,P<0.05)。肝被膜侵犯、CA19-9>37kU/L、中性粒细胞及淋巴细胞计数异常是行淋巴结清扫的ICC患者生存获益的术前临床病理特征(χ^(2)=9.548,4.800,13.715,13.412;P<0.05)。结论当肝被膜侵犯、术前CA19-9>37kU/L、中性粒细胞及淋巴细胞计数异常时,淋巴结清扫可使ICC根治性切除术患者生存获益。

Objective To investigate the preoperative clinicopathological features of patients who obtained survival benefit from lymph node dissection in resection of intrahepatic cholangiocarcinoma(ICC).Methods Clinical data of 415 patients who underwent ICC radical resection in 8 hospitals in China from January 2010 to December 2018 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,225 patients were male and 190 female,aged from 27 to 83 years,with a median age of 59 years.All patients were divided into the dissection and non-dissection groups according to whether intraoperative lymph node dissection was performed.Propensity score matching(PSM)was used to balance the differences between the dissection and non-dissection groups.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Preoperative clinicopathological characteristics of patients obtaining survival benefit in the dissection group were analyzed.Results Prior to PSM,283 patients were allocated in the dissection group and 132 cases in the non-dissection group.After 1∶1 PSM,228 patients were selected,with 114 cases in each group.The median survival in the dissection and non-dissection groups was 35.4 and 25.0 months,and the overall survival rate in the dissection group was significantly higher than that in the non-dissection group(χ^(2)=5.404,P<0.05).Glisson's capsule invasion,CA19-9>37 kU/L,abnormal neutrophil and lymphocyte count were the preoperative clinicopathological features of ICC patients obtaining survival benefit from lymph node dissection(χ^(2)=9.548,4.800,13.715,13.412;P<0.05).Conclusions Lymph node dissection in ICC radical resection can bring survival benefit to patients with hepatic capsule invasion,preoperative CA19-9>37 kU/L,abnormal neutrophil and lymphocyte count.