摘要
目的分析肝外胆管癌治疗方法及预后影响因素。方法回顾性分析58例肝外胆管癌患者的临床病理资料,应用Kaplan-Meier法计算生存率,对可能影响患者预后的因素分别进行单因素分析(log-rank检验),应用Cox比例风险模型进行多因素统计分析。结果 58例患者中位生存期为33个月,1、3和5年疾病特异性生存率分别为78.6%、39.3%和17.8%。根治性手术组与非根治性手术组患者1、3、5年疾病特异性生存率分别为88.2%、70.1%、37.4%和71.7%、23.0%、7.8%(P=0.001);行辅助化疗和未行辅助化疗两组3和5年疾病特异性生存率分别为69.1%、39.8%和40.1%、9.3%(P=0.029)。单因素分析的结果显示患者治疗前血清总胆红素、白蛋白水平、组织分化程度、是否行根治术、切缘有无残存肿瘤、有无脉管侵犯、有无淋巴结转移、肝转移以及是否行辅助化疗等因素对生存的影响有统计学意义(P<0.05)。多因素分析结果示根治术、切缘阳性、淋巴转移是影响肝外胆管癌患者生存的重要因素(P<0.05)。结论根治术、淋巴结转移、切缘阳性等因素对肝外胆管癌患者的生存产生重要影响;在肝外胆管癌诊治中,根治术仍是改善预后的重要措施,辅助化疗可能改善生存,但不是独立预后因素。
Objective To analyze the therapeutics of extrahepatic cholangiocarcinoma （ECC） and the factors that may affect the prognosis. Methods The clinicopathological data was retrospectively analyzed in 58 cases of extrahepatic cholangiocarcinoma. The Kaplan-Meier method was used to estimate the overall survival and disease specific survival rates（DSSR） for these patients. And the factors that may influence the prognosis and survival of ECC patients were analyzed using univariate （ log-rank test） and multivariate Cox proportional hazard models. Results The median survival time was 33 months for all patients. The actual DSSR for all patients was 78.6% at 1 year, 39.3% at 3 years, and 17.8% at 5 years. The 1-, 3- and 5-year DSSRs of radi- cal resection eases were 88.2% ,70. 1% and 37.4% , respectively, and those of non-radical resection cases were 71.7% ,23.0% and 7.8% （P = 0. 001 ）. The 3- and 5-year DSSRs of patients who received adjuvant chemotherapy were 69.1% and 39.8%, while the 3- and 5-year DSSRs were 40.1% and 9.3% respectively for non-adjuvant chemotherapy patients （ P = 0.029 ）. Univariate analysis showed that elevated baseline serum total bilirubin, low albumin level, poor histological grade, positive surgical margin, vascular invasion, lymph node metastasis, liver metastasis were associated with shorter survival, while the radical surgery and adjuvant chemotherapy were associated with better survival of ECC （P 〈 0.05 ）. Multivariate analysis by Cox Proportional Hazard Model showed that radical surgery, positive surgical margin and lymph node metastasis were the significant independent prognostic factors in patients with ECC （P 〈 0.05）. Conclusions Factors including radical sur- gery, lymph node metastasis and positive surgical margin status are significantly impacting on the survival of ECC. In the management of ECC, radical surgery remains the main therapeutics which can improve the progno- sis, and, adjuvant chemotherapy may improve the survival, but it is not the independent prognosticator.
出处
《中国现代手术学杂志》
2013年第3期171-176,共6页
Chinese Journal of Modern Operative Surgery
关键词
胆管肿瘤
胆道外科手术
存活率分析
抗肿瘤联合化疗方案
预后
bile duct neoplasms
biliary tract surgical procedures
survival analysis
iantineoplastic combined chemotherapy protocols
prognosis
作者简介
帕尔哈提．阿布都热衣木，男，41岁，新疆医科大学第六附属医院普外科副主任医师。
通信作者：艾力江·吐尔逊，男，44岁，新疆医科大学第一附属医院肿瘤中心主治医师。
