摘要
背景与目的:肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)发病率低,治疗效果不理想。本研究旨在分析可手术治疗和无法手术治疗ICC患者的预后相关因素和生存情况。方法:回顾性收集1997年1月至2007年12月在中山大学肿瘤防治中心经病理诊断并治疗的84例ICC患者的临床资料,采用Kaplan-Meier法进行单因素生存分析,用Cox模型进行多因素分析。结果:84例患者中采用手术治疗者56例(66.7%),非手术治疗者28例(33.3%);手术治疗者中根治性切除者27例(48.2%),姑息性切除者29例(51.8%)。无法手术治疗患者、姑息手术治疗患者及根治性手术治疗患者的2年总生存率分别是3.1%、16.0%及49.2%,根治性切除患者的2年生存率明显高于姑息性切除患者(P<0.01)。对手术患者进行单因素生存分析,结果显示,手术方式、病理类型、肿块大小、肿块数目、淋巴结侵犯、肝脏侵犯、门脉癌栓、术后血清白蛋白水平和术前血清CEA、CA199、TBIL、ALT、AST水平与预后相关;多因素生存分析结果显示,手术方式、病理类型和术前血清CEA、CA199、TBIL水平是手术患者的独立预后因素。未手术患者的单因素生存分析结果显示病理类型和血清CA199水平与预后相关,多因素生存分析结果显示只有病理类型为独立预后因素。化疗在手术患者组和非手术患者组均未显示生存优势(P=0.30和P=0.78)。结论:根治性切除是ICC患者获得长期生存的主要有效治疗手段,术前血清CEA、CA199、TBIL水平是手术患者重要的预后因素。
Background and Objective： The incidence of intrahepatic cholangiocarcinoma （ICC） is low. Current treatment for ICC is unsatisfied. This study was to investigate the prognosis of patients with resectable or unresectable ICC. Methods： Clinical data of 84 patients with pathologically confirmed ICC treated at Cancer Center, Sun Yat-sen University from January 1997 to December 2007 were reviewed. Survival and prognosis were analyzed by Kaplan-Meier method and Cox regression model. Results： Of the 84 patients, 56 （66.7%） had resectable ICC, and 28 （33.3%） had unresectable ICC. Among the 56 patients with resectable tCC, 27 （48.2%） underwent radical resection, and 29 （51.8%） underwent palliative resection. The 2-year overall survival rate was 3.t% in unresectable ICC group; it was significantly higher in radical resection group than in palliative resection group （P〈0.01）. For the patients with resectable ICC, univariate analysis revealed that operation pattern, histological type, tumor size and number, lymph node metastasis, intrahepatic metastasis, portal vein thrombus, postoperative serum level of albumin, preoperative serum levels of CEA, CA199, TBIL, ALT and AST were related to the prognosis; multivariate analysis found that operation pattern, histological type, tumor number, preoperative serum levels of CEA, CA199 and TBIL were independent prognostic factors. For the patients with unresectable ICC, univariate analysis found that histological type and preoperative serum level of CA199 were related to the prognosis; whereas multivariate analysis found that histological type was the only independent prognostic factor. Chemotherapy showed no survival benefit in both resectable and unresectable ICC groups （P=0.30, P=0.78）. Conclusions= Radical resection is the main effective treatment for ICC patients to achieve long-term survival. Preoperative serum levels of CEA, CA199 and TBIL are significant prognostic factor for patients with resectable ICC.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2009年第5期528-532,共5页
Chinese Journal of Cancer
关键词
肝肿瘤
肝内胆管细胞癌
手术治疗
化学疗法
预后因素
生存率
liver neoplasm, intrahepatic cholangiocarcinoma, surgical treatment, chemotherapy, prognostic factor, survival
作者简介
通讯作者：徐瑞华wCorrespondence to： Rui-Hua Xu Tel. ： 86.20.87343468 Fax ： 86.20.87343468 Email ： xurh@mail.sysu.edu.cn
