肝内胆管结石相关性与乙肝相关性肝内胆管癌患者预后比较及对预后的影响

Comparative study on the prognosis of hepatolithiasis and hepatitis B virus-associated intrahepatic cholangiocarcinoma

目的比较行根治性切除的肝内胆管结石相关性与乙型病毒性肝炎(乙肝)相关性肝内胆管癌(ICC)患者的预后,及二者对预后的影响。方法回顾分析2012年1月至2024年2月宁波大学附属李惠利医院收治的行根治术的146例ICC患者临床资料。最终入组69例,其中男性40例,女性29例,年龄(62.9±10.2)岁。69例患者中伴肝内胆管结石纳入结石组(n=40),感染乙肝纳入乙肝组(n=29)。Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。采用Cox比例风险回归模型进行多因素分析,分析肝内胆管结石和乙肝对患者预后的影响。结果结石组ICC患者中位总生存期为16个月,乙肝组为27个月。结石组术后1、3、5年累积生存率分别为56.6%、23.2%、10.3%,低于乙肝组的72.0%、50.7%、43.4%,差异有统计学意义(χ^(2)=5.95,P=0.015)。结石组和乙肝组的中位无复发生存期分别为12个月和23个月。结石组术后1、3年无复发生存率分别为49.2%、18.1%,低于乙肝组的65.0%、39.8%,差异有统计学意义(χ^(2)=3.94,P=0.047)。单因素分析肝内胆管结石与预后相关(χ^(2)=5.95,均P=0.015)。多因素Cox回归分析显示肝内胆管结石和乙肝对ICC患者手术后预后无影响(均P>0.05)。结论相对于乙肝感染,伴肝内胆管结石ICC患者预后更差。肝内胆管结石和乙肝感染对ICC手术后预后均无影响。

Objective To compare the prognosis of patients with hepatolithiasis-associated intrahepatic cholangiocarcinoma(ICC)and hepatitis B virus(HBV)-associated ICC after radical resection.Methods The clinicopathological and survival data of 69 patients with ICC undergoing radical resection in the Department of Hepatobiliary and Pancreatic Surgery,Lihuili Hospital Affiliated to Ningbo University from January 2012 to February 2024 were retrospectively analyzed,including 40 males and 29 females,aged(62.9±10.2)years.Patients were divided into the stone group(n=40,with hepatolithiasis)and HBV group(n=29,with HBV).Kaplan-Meier method was used for survival analysis,and log-rank test was used for survival rate comparison.Cox proportional hazard regression model was used for multivariate analysis to analyze the effect of hepatolithiasis and HBV on the prognosis.Results The median overall survival of ICC patients in the stone group was 16 months,and that in the HBV group was 27 months.The 1-,3-,and 5-year cumulative survivals of the stone group were 56.6%,23.2%,and 10.3%,respectively,which were lower than those of the HBV group(72.0%,50.7%,and 43.4%,respectively,χ^(2)=5.95,P=0.015).The median recurrence-free survivals(RFS)of the stone group and the HBV group were 12 months and 23 months,respectively.The 1-year and 3-year RFS of the stone group were 49.2%and 18.1%,which were lower than those of the HBV group(65.0%and 39.8%,respectively,χ^(2)=3.94,P=0.047).Univariate analysis showed that hepatolithiasis was assciated with prognosis(χ^(2)=5.95,P=0.015).Multivariate Cox regression analysis showed that hepatolithiasis and hepatitis B virus infection had no effect on the prognosis of ICC patients after surgery(all P>0.05).Conclusion Compared to HBV infection,ICC patients with hepatolithiasis have a worse prognosis.Hepatolithiasis and HBV infection have no effect on the prognosis of ICC after radical resection.