肝内胆管癌不同大体病理类型的预后分析及临床特征的多中心回顾性研究

Prognostic analyses and clinical characteristics of different gross pathological types of intrahepatic cholangiocarcinoma:a multicenter retrospective study

目的分析肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)不同大体病理类型对预后的影响以及不同大体病理类型与临床特征的关系。方法采用回顾性病例对照研究方法,收集于2010-2020年中国13家三级甲等医院行根治性切除术的660例ICC病人的临床和病理学资料,进行1∶1倾向性评分匹配(卡钳值:0.02),采用Kaplan-Meier法绘制生存曲线,log-rank检验进行生存分析。单因素分析采用χ^(2)检验,P<0.05为差异有统计学意义。结果1∶1倾向性评分匹配后,肿块型ICC病人与管周浸润型ICC病人的预后差异有统计学意义(P<0.05)。当ICC病人处于T1分期时,肿块型ICC病人与管周浸润型ICC病人的预后差异有统计学意义(P<0.05)。肿块型ICC病人(513例)和管周浸润型ICC病人(102例)在地区、年龄、结石病史、Child-Pugh分级、腹痛、腹胀、黄疸、发热、中性粒细胞计数、淋巴细胞计数、谷丙转氨酶、总胆红素、总白蛋白、肿瘤位置、肿瘤大小方面比较,差异均有统计学意义(均P<0.05);肿块型ICC和管内生长型ICC病人(45例)在地区、年龄、谷丙转氨酶、肿瘤大小情况比较,差异均有统计学意义(均P<0.05)。结论与肿块型相比,管周浸润型ICC病人具有更良好的预后。可进一步探究对管周浸润型ICC病人进行免疫治疗的有效性,以及肿块型ICC病人对靶向治疗的敏感性。

Objective To explore the prognostic impact of different gross pathological types of intrahepatic cholangiocarcinoma(ICC)and elucidate the relationship between different gross pathological types and clinical features.Methods For this retrospective case-control study,clinicopathological data were retrospectively reviewed for 660 ICC patients undergoing radical resection at 13 tertiary care hospitals in China from 2010 to 2020.A 1∶1 propensity score matching(caliper value:0.02)was performed.Survival curves were plotted with Kaplan-Meier method and log-rank tests employed for survival analysis.χ^(2) test was used for univariate analysis and P<0.05 denoted significant statistical difference.Results After propensity score matching,significant statistical difference existed in prognosis between patients with mass ICC and those with peritubular infiltrative ICC(P<0.05).For ICC patients in T1 stage,significant statistical difference existed in prognosis between patients with mass ICC and those with peritubular infiltrative ICC(P<0.05).The differences were statistically significant(P<0.05)when comparing region,age,stone history,Child-Pugh classification,abdominal pain,abdominal distension,jaundice,fever,neutrophil count,lymphocyte count,alanine aminotransferase(ALT),total bilirubin,total albumin,tumor location and tumor size in patients with mass ICC and peritubular infiltrative ICC;As for region,age,ALT and tumor size in patients with mass ICC and intraductal growth ICC,the differences were statistically significant(P<0.05)when comparing the situation of mass-type ICC and intraductal growth-type ICC patients in terms of region,age,ALT and tumor size.Conclusion Compared with mass type,patients with peritubular infiltrative ICC have a better prognosis.The effectiveness of immunotherapy in patients with peritubular infiltrative ICC and the sensitivity of patients with mass ICC to targeted therapy may be further explored.