胆管内乳头状肿瘤临床病理学分析及预后因素评价

Clinical pathological analysis and prognostic factors evaluation of intraductal papillary neoplasm of the bile duct

目的探讨胆管内乳头状肿瘤(IPNB)的临床病理学特征及影响恶性病人生存的危险因素。方法回顾性分析2014年1月至2020年12月浙江大学医学院附属邵逸夫医院收治的33例IPNB病人的临床病理学特征及术后随访资料。比较不同组织学分级及不同解剖分型病人的临床病理学特征,并分析影响恶性IPNB病人生存的危险因素。结果与良性组相比,恶性IPNB病人年龄较大(P=0.050),CA19-9的中位数水平更高(P=0.004),术前CT或MR检查提示胆管内肿块比例更高(P=0.027),手术切除范围差异有统计学意义(P=0.008)。恶性病人的总生存率低于良性组(P=0.012)。肝内型、肝外型与弥漫型IPNB病人在术前腹痛症状(P=0.013)方面差异有统计学意义。多因素Cox回归分析结果显示,术后复发是恶性IPNB病人不良预后的独立危险因素(P=0.013)。结论改良解剖学分型能够一定程度上指导临床制定手术切除范围,恶性IPNB病人预后相对较差,术后复发与恶性IPNB病人的不良预后显著相关。

Objective To investigate the clinical pathological features of intraductal papillary neoplasm of the bile duct(IPNB)and the risk factors affecting the survival of malignant patients.Methods The clinical pathological features and postoperative follow-up data of 33 IPNB patients admitted to Sir Run Run Shaw Hospital affiliated with Zhejiang University from January 2014 to December 2020 were retrospectively analyzed.The clinical pathological features of IPNB patients with different histological grades and anatomical types were compared,and the risk factors affecting the survival of malignant IPNB patients were analyzed.Results In comparison to the benign group,patients with malignant IPNB were older(P=0.050),had higher median levels of CA19-9(P=0.004),and were more likely to show intraductal masses on preoperative CT or MR imaging(P=0.027).There were also differences in the extent of surgical resection(P=0.008).The overall survival rate of patients with malignant IPNB was lower than that of the benign group(P=0.012).Differences were observed in preoperative abdominal pain symptoms among patients with intrahepatic,extrahepatic,and diffuse types of IPNB(P=0.013).Multivariate Cox regression analysis indicated that postoperative recurrence was an independent risk factor for poor prognosis in patients with malignant IPNB(P=0.013).Conclusion The modified anatomical classification can provide some guidance for the resection range of IPNB lesions.The prognosis of malignant IPNB patients is relatively poor,and postoperative recurrence is significantly associated with the poor prognosis of malignant IPNB patients.