摘要
目的探讨第8版美国癌症联合委员会(AJCC)分期系统对肝内胆管癌(ICC)术后病人预后评估的价值。方法回顾性分析2013年1月至2018年12月海军军医大学东方肝胆外科医院收治的155例行根治性切除术后ICC病人的临床及病理资料,所有病人均根据第8版AJCC分期系统进行分期,采用Kaplan-Meier法进行生存分析,采用COX比例风险模型进行多因素分析,用受试者工作特征曲线(ROC曲线)和曲线下面积(AUC)判断分期系统对预后的评估能力。结果(1)155例病人随访率为70.3%,中位随访时间为26(1~67)个月,术后病人1、3、5年存活率分别为81%、39%、25%。(2)T1a、T1b、T2、T3、T4期的中位生存时间分别是45.5、28.8、19.1、18.9、16.2个月(P<0.001);N0、N1期的中位生存时间分别为33.4、15.8个月(P<0.001);ⅠA、ⅠB、Ⅱ、ⅢA、ⅢB期的中位生存时间分别是46.8、32.3、21.6、20.3、15.6个月(P<0.001)。T分期、N分期和TNM分期的ROC曲线分析AUC分别为0.704、0.718、0.698。(3)单因素分析提示CA19-9、肿瘤数目、血管侵犯、术中输血、T分期、N分期和TNM分期是ICC病人预后的危险因素(P<0.05);多因素分析提示肿瘤数目、术中输血、N分期是ICC病人预后的独立危险因素(P<0.05)。结论第8版AJCC分期系统对ICC术后预后评估具有一定的价值。多发肿瘤、术中输血、N分期是ICC病人的独立预后因素。
Objective To explore the value of the 8 th edition of the AJCC staging system in evaluating the prognosis of patients with intrahepatic cholangiocarcinoma(ICC)after operation.Methods A total of 155 patients with ICC after radical resection in Eastern Hepatobiliary Surgery Hospital,Naval Military Medical University from January 2013 to December 2018 were analyzed retrospectively.All patients were staged according to the 8 th edition of the AJCC staging system.The survival rates were estimated using Kaplan-Meier methods.Multivariate analysis was assessed by Cox proportional hazards regression analysis.The predictive ability of staging systems was evaluated by receiver operating characteristic curve(ROC)and area under curve(AUC).Results(1)The follow-up rate of 155 patients was 70.3%,and the median follow-up time was 26(1-67)months.The 1-,3-,and 5-year survival rates of patients after surgery were81%,39%,and 25%,respectively.(2)The median survival time of T1 a,T1 b,T2,T3,and T4 stages was 45.5,28.8,19.1,18.9 and 16.2 months,respectively(P<0.001);The median survival time of N0 and N1 stages was 33.4 and 15.8 months,respectively(P<0.001);The median survival time ofⅠA,ⅠB,Ⅱ,ⅢA andⅢB stages was 46.8,32.3,21.6,20.3 and 15.6 months,respectively(P<0.001).The ROC curve analysis of T stage,N stage and TNM stage indicated that the AUC were0.704,0.718 and 0.698,respectively.(3)Univariate analysis indicated that CA19-9,tumor number,vascular invasion,intraoperative blood transfusion,T stage,N stage and TNM stage were risk factors for prognosis in patients with ICC(P<0.05).Multivariate analysis indicated that the number of tumors,intraoperative blood transfusion,and N stage were independent risk factors for prognosis in patients with ICC(P<0.05).Conclusion The 8 th edition of the AJCC staging system is of certain value in the evaluation of postoperative prognosis of intrahepatic cholangiocarcinoma.Multiple tumors,intraoperative blood transfusion and N stage are independent prognostic factors for ICC patients.
作者
杨发才
薄志远
李梦
段安琪
沈宁佳
张永杰
李敬东
邱应和
YANG Fa-cai;BO Zhi-yuan;LI Meng(Department of Hepatology,Affiliated Hospital of North Sichuan Medical College,Nanchong 617000,China;不详)
出处
《中国实用外科杂志》
CSCD
北大核心
2019年第11期1189-1194,共6页
Chinese Journal of Practical Surgery
基金
国家自然科学基金(No.81772528).
作者简介
通信作者:邱应和,E-mail:Qiuyinghe@aliyun.com;通信作者:李敬东,Email:lijingdong358@126.com;杨发才,对文章有同等贡献,均为第一作者;薄志远,对文章有同等贡献,均为第一作者
