肿瘤大小对单发肝内胆管癌术后预后影响的多中心回顾性分析

Prognostic impact of tumor size on postoperative prognosis of solitary intrahepatic cholangiocarcinoma:a multicenter retrospective analysis

背景与目的:肝内胆管癌(ICC)是一种预后差的高度恶性肿瘤。在临床上,手术切除是治疗的首选,但患者术后复发率高,而且近30年来其发病率持续上升。肿瘤大小作为重要的预后因素之一,对患者的生存预后有着显著影响。本研究探讨肿瘤大小对单发ICC患者行根治性切除术后预后的影响,以期为临床提供更准确的预后评估,从而指导治疗决策。方法:回顾性分析2011年12月—2017年12月中国13家医院654例接受根治性切除术且术后病理学诊断为ICC患者的临床病理学资料。通过Cox回归分析ICC患者预后的危险因素,采用Kaplan-Meier法绘制生存曲线,并使用Log-rank检验比较不同肿瘤大小患者之间总体生存(OS)的差异。结果:最终纳入307例患者,其中肿瘤大小≤3 cm 40例(13.03%),肿瘤大小>5 cm 177例(57.65%),肿瘤大小>3~5 cm 90例(29.32%)。Cox回归分析显示,切缘状态、病理淋巴结状态、卫星灶、肿瘤大小>5 cm是单发ICC患者预后的独立危险因素(均P<0.05)。肿瘤大小≤3 cm的患者1、3、5年OS率分别为83.3%、73.8%、54.7%,肿瘤大小>3~5 cm的患者1、3、5年OS率分别为81.1%、40.7%、36.1%,肿瘤大小>5 cm的患者1、3、5年OS率分别为72.1%、37.7%、29.0%,三组OS率差异有统计学意义(P=0.021)。将不同肿瘤大小的患者中行与未行淋巴结清扫的患者分组比较,结果显示,在肿瘤大小≤3 cm的患者中,两组OS率无明显差异(P=0.780);肿瘤大小>3~5 cm的患者中,未进行淋巴结清扫者OS率明显高于进行清扫者(P=0.017);肿瘤大小>5 cm的患者中,进行淋巴结清扫的OS率明显高于未进行清扫者(P=0.025)。结论:在单发ICC患者中,肿瘤大小≤3 cm的患者具有更好的预后。对于肿瘤大小>5 cm的单发ICC患者建议同时进行淋巴结清扫手术。

Background and Aims:Intrahepatic cholangiocarcinoma(ICC)is a highly malignant tumor with poor prognosis.Surgical resection is the preferred treatment in clinical practice,but patients often experience high rates of postoperative recurrence.the incidence of ICC has been steadily increasing over the past 30 years.Tumor size,as an important prognostic factor,significantly affects the survival outcomes of patients.This study was conducted to investigate the impact of tumor size on the prognosis of patients with solitary ICC after radical resection,so as to provide more accurate prognostic assessment for clinical decision-making.Methods:The clinicopathologic data of 654 patients who underwent radical resection and were pathologically diagnosed with ICC between December 2011 and December 2017 in 13 hospitals across China were retrospectively analyzed.Cox regression analysis was used to identify prognostic factors for ICC patients,Kaplan-Meier method was used to plot survival curves,and Log-rank test was used to compare overall survival(OS)differences among patients with different tumor sizes.Results:A total of 307 patients were included.There were 40 cases(13.03%)with tumor size≤3 cm,177 cases(57.65%)with tumor size>5 cm,and 90 cases(29.32%)with tumor size>3-5 cm.Cox regression analysis revealed that margin status,pathological lymph node status,satellite nodules,and tumor size>5 cm were independent risk factors for the prognosis of solitary ICC patients(all P<0.05).The 1-,3-,and 5-year OS rates for patients with tumors≤3 cm were 83.3%,73.8%,and 54.7%,for patients with tumors>3-5 cm were 81.1%,40.7%,and 36.1%,and for patients with tumors>5 cm were 72.1%,37.7%,and 29.0%,respectively(P=0.021).Patients with different tumor sizes were grouped and compared based on whether lymph node dissection was performed.The results showed that in ICC patients with tumor size≤3 cm,there was no significant difference in OS rate between the two groups(P=0.780);in patients with tumor size>3-5 cm,those not undergoing lymph node dissection had ignificantly higher OS rate than those undergoing lymph node dissection(P=0.017);in patients with tumor size>5 cm,those who underwent lymph node dissection had significantly higher OS rate than those who did not(P=0.025).Conclusion:In patients with solitary ICC,those with tumors≤3 cm have a relatively better prognosis.For patients with solitary ICC and tumors>5 cm,lymph node dissection surgery is recommended.