手术后不同分型肝内胆管癌预后危险因素分析

Clinicopathological features of different types of intrahepatic cholangiocarcinoma and prognostic analysis of lymph node clearance

目的 探索大胆管型和小胆管型肝内胆管癌(intrahepatic cholangiocarcinoma, ICC)的临床病理学特点及其与治疗和预后的相关性。方法 回顾性收集2012年7月至2022年3月南京大学医学院附属鼓楼医院收治的189例ICC病例的临床病理及预后资料,统计大胆管型、小胆管型ICC的临床病理资料差异,应用单因素和多因素分析预后的独立风险因素,并使用Kaplan-Meier法对大小胆管分型、淋巴结转移等风险因素进行分析。结果 189例ICC中,大胆管型ICC58例(30.7%),小胆管型ICC131例(69.3%)。组间比较发现小胆管型肿瘤最大径较大,且术前血总胆红素、直接胆红素及糖类抗原19-9水平均显著低于大胆管型,差异均有统计学意义(均P<0.05)。生存分析结果表明:与小胆管型比较,大胆管型ICC预后更差(P<0.05)。大胆管型ICC预后的独立危险因素仅有TNM分期[HR=1.586,95%CI(1.035,2.432),P=0.034];小胆管型ICC预后的独立风险因素有肿瘤数量、肿瘤最大径和TNM分期;总体ICC队列预后的独立危险因素为:肿瘤数量[HR=2.152,95%CI(1.116,4.152),P=0.022],肿瘤大小[HR=1.104,95%CI(1.007,1.211),P=0.035],组织类型[HR=1.853,95%CI(1.091,3.149),P=0.023],TNM分期[HR=1.540,95%CI(1.161,2.042),P=0.003],胆道结石病史[HR=2.279,95%CI(1.333,3.896),P=0.003]。结论 ICC组织学分型对肿瘤预后评估和肿瘤诊治有重要指导意义,同时淋巴结转移的病理学评估同样有重要的预后指导意义,应当按美国癌症联合委员会(AJCC)推荐要求进行必要的区域淋巴结清扫。

Objective According to the Edition V WHO Classification of Tumors of Digestive System in 2019,intrahepatic cholangiocarcinoma(ICC)may be classified into large duct and small duct types.There is a lack of clinical knowledge about two type of ICC.The aim of this study was to explore the clinicopathological characteristics of different subtypes of ICC and examine their correlation with treatment and prognosis.Methods Clinicopathological and prognostic data were retrospectively collected from 189 ICC cases from July 2012 to March 2022.And the differences in clinical history data between two types were evaluated.Univariate and multifactorial analyses were performed for identifying tumor-independent risk factors.Kaplan-Meier survival analysis was applied.Results Among them,58(30.7%)were of large duct type and 131(69.3%)of small bile duct type.Comparison between groups indicated that small duct type had larger tumor size.And preoperative levels of blood total bilirubin,direct bilirubin and CA19-9 were significantly lower than those of large duct type.Survival analysis revealed that the prognosis of large duct type ICC was worse than that of small duct type(P<0.05).Independent risk factor for prognosis of both small and large bile duct type ICC was TNM stage[HR=1.586,95%CI(1.035,2.432),P=0.034];independent risk factors for prognosis of the overall ICC cohort were tumor number[HR=2.152,95%CI(1.116,4.152),P=0.022],tumor size[HR=1.104,95%CI(1.007,1.211),P=0.035],tissue type[HR=1.853,95%CI(1.091,3.149),P=0.023],TNM stage[HR=1.540,95%CI(1.161,2.042),P=0.003]and history of biliary stones[HR=2.279,95%CI(1.333,3.896),P=0.003].Conclusion ICC histologic staging has important prognostic implications for both tumor prognosis and tumor management.And pathologic assessment of lymph node metastasis also has important prognostic implications.Regional lymph node dissection should be performed according to the recommendations of American Joint Committee on Cancer(AJCC).