背景与目的:肝内胆管癌(ICC)近年来发病率不断升高,该疾病起病较为隐匿、多无明显症状,早期诊断率较低,根治性切除仍是其可能获得痊愈的唯一治疗手段,但由于肿瘤已多发转移、剩余肝储备不足、患者一般情况不能耐受手术等原因,其根治性切除率较低.因此,本研究探讨阳性淋巴结个数与ICC患者术后预后的关系,以期为ICC手术预后评价提供参考,为术后治疗策略的选择提供依据. 方法:回顾性收集2017年9月—2020年9月中国人民解放军联勤保障部队第九○四医院肝胆外科行根治性手术切除术150例ICC患者的临床资料,分析影响患者术后生存的相关因素,以及不同阳性淋巴结个数(N0:无淋巴结转移;N1:淋巴结转移个数＜3枚;N2:淋巴结转移个数≥3枚)患者术后生存的差异. 结果:单因素分析显示,术前糖类抗原19-9(CA19-9)水平、术前甲胎蛋白水平、切缘状态、淋巴结阳性个数与ICC患者术后生存明显有关(均P＜0.05).多因素分析显示,切缘状态(P--0.003)、术前CA19-9水平(P=0.008)、阳性淋巴结个数(P＜0.001)是影响术后预后的独立危险因素.全组150例ICC患者术后1、2、3年生存率分别为50.67％、24.67％、17.33％.62例N0患者术后1、2、3年生存率分别为 79.03％、43.55％、32.25％;36 例 N1 患者术后 1、2、3 年生存率分别为 47.22％、27.78％、16.67％;52例N2患者术后1、2、3年生存率分别为19.23％、0、0,三组不同淋巴结状态患者间总体生存率差异有统计学意义(x2=33.516,P＜0.001),且生存率在N0、N1、N2患者中依次降低(均P＜0.05). 结论:阳性淋巴结个数是影响ICC患者根治术后预后的独立危险因素,以阳性淋巴结3枚作为临界值结合其他相关因素的评估,可完善临床上对ICC患者的危险分级,为ICC术后治疗策略提供理论依据.
Background and Aims:The incidence of intrahepatic cholangiocarcinoma(ICC)has been increasing in recent years.This disease often presents insidiously with few obvious symptoms,leading to a low rate of early diagnosis.Radical resection remains the only potential curative treatment,but due to reasons such as widespread tumor metastasis,inadequate residual liver reserve,and poor general condition of patients,the rate of radical resection is low.Therefore,this study was performed to investigate the relationship between the number of positive lymph nodes and the postoperative prognosis of ICC patients,in order to provide references for the prognosis evaluation of ICC surgery and guidance for postoperative treatment strategies. Methods:The clinical data of 150 ICC patients undergoing radical resection in the Department of Hepatobiliary Surgery,the 904th Hospital of Joint Logistic Support Force of PLA from September 2017 to September 2020 were retrospectively collected.Factors influencing postoperative survival of patients and the differences in postoperative survival among patients with different numbers of positive lymph nodes(N0:no lymph node metastasis;N1:less than 3 lymph node metastases;N2:3 or more lymph node metastases)were analyzed. Results:Univariate analysis showed that preoperative levels of CA19-9 and AFP,margin status,and the number of positive lymph nodes were significantly associated with postoperative survival of ICC patients(all P＜0.05).Multivariate analysis revealed that margin status(P=0.003),preoperative CA19-9 level(P=0.008),and the number of positive lymph nodes(P＜0.001)were independent risk factors affecting postoperative prognosis.The 1-,2-,and 3-year postoperative survival rates of all 150 ICC patients were 50.67％,24.67％,and 17.33％,respectively.The survival rates of 62 N0 patients were 79.03％,43.55％,and 32.25％ at 1,2,and 3 years,respectively;those of 36 N1 patients were 47.22％,27.78％,and 16.67％,respectively;and those of 52 N2 patients were 19.23％,0,and 0,respectively.There was a statistically significant difference in overall survival among the three groups with different lymph node profiles(x2=33.516,P＜0.001),and the survival rates sequentially decreased in N0,N1,and N2 patients(all P＜0.05). Conclusion:The number of positive lymph nodes is an independent risk factor influencing the postoperative prognosis of ICC patients.Using 3 positive lymph nodes as a cutoff value,combined with assessment of other relevant factors,can improve the risk stratification of ICC patients in clinical practice and provide a theoretical basis for postoperative treatment strategies for ICC.
谢伟选;柏杨;朱庆洲;罗昆仑
中国人民解放军联勤保障部队第九○四医院肝胆外科,江苏无锡 214044安徽医科大学无锡临床学院,江苏无锡 214044中国人民解放军联勤保障部队第九○四医院肝胆外科,江苏无锡 214044||安徽医科大学无锡临床学院,江苏无锡 214044
临床医学
胆管肿瘤;胆管,肝内;淋巴转移;预后
Bile Duct Neoplasms;Bile Ducts,Intrahepatic;Lymphatic Metastasis;Prognosis
《中国普通外科杂志》 2024 (002)
202-209 / 8
安徽医科大学校科研基金项目青年科学基金资助项目(2021xkj120).
10.7659/j.issn.1005-6947.2024.02.006
评论