摘要
目的探讨影响肝内胆管细胞癌(ICC)患者根治性切除术后预后相关因素及腹腔淋巴结清扫范围对ICC患者术后预后的价值。方法回顾性分析从2013年10月至2017年10月在郑州大学附属肿瘤医院肝胆胰外科行根治性切除术的ICC患者临床资料,根据腹腔淋巴结清扫范围将患者分为未清扫组、常规清扫组和扩大清扫组,比较三组患者预后情况并釆用Cox逐步回归模型分析ICC患者预后的独立危险因素。结果共纳入178例患者,其中男性109例,女性69例,年龄30-81岁,平均59岁。根据腹腔淋巴结清扫范围,未清扫组纳入80例、常规清扫组纳入34例、扩大清扫组纳入64例。178例患者肝切除术后3年累积生存率为29.2%(52/178),总体中位生存时间25.8个月。未清扫组、常规清扫组、扩大清扫组的3年累积生存率分别为10.0%(8/80)、52.9%(18/34)、40.6%(26/64),三组整体生存率比较差异有统计学意义(P<0.05)。三组间两两比较结果显示:常规清扫组与扩大清扫组生存率比较,差异无统计学意义(P>0.05);未清扫组与常规清扫组、未清扫组与扩大清扫组生存率比较,差异有统计学意义(P<0.05)。单因素分析显示术前糖类抗原19-9(CA19-9)、肿瘤最大径、门静脉癌栓、腹腔淋巴结清扫范围与ICC患者预后有关(P<0.05);多因素分析显示术前CA19-9、肿瘤最大径、腹腔淋巴结清扫范围与患者生存有关(P<0.05)。结论CA19-9,肿瘤最大径、腹腔淋巴结清扫范围是ICC患者术后生存的独立危险因素。对于可行手术切除术的ICC患者,行腹腔淋巴结常规清扫术即可达到较好的预后效果,无需扩大腹腔淋巴结清扫范围。
Objective To study factors affecting prognosis of patients with intrahepatic cholangiocarcinoma(ICC),focusing on the correlation between extent of lymph node dissection and prognosis of patients with ICC.Methods The clinical data of ICC patients who underwent radical resection at the Hepatobiliary and Pancreatic Surgery of Affiliated Cancer Hospital of Zhengzhou University from October 2013 to October 2017 were retrospectively analyzed.According to the extent of lymph node dissection,the patients were divided into the non-dissected lymph node group,the routine dissection lymph node group and the extended lymph node dissection group.The prognoses of the three groups were compared.The Cox stepwise regression model was used to analyze the independent risk factors for prognosis of patients with ICC.Results The 178 patients included 109 males and 69 females.Their ages ranged from 30 to 81 years(average 59 years).There were 80 patients in the non-dissected group,34 patients in the routine lymph node dissection group,and 64 patients in the extended lymph node dissection group.The overall survival rates of the 178 patients at 3 years after liver resection was 29.2%(52/178),overall median survival 25.8 months.The 3-year survival rates of the non-dissected group,routine dissection group,and extended dissection group were 10.0%(8/80),52.9%(18/34),40.6%(26/64),respectively.The differences among the three groups were significant(P<0.05).Comparison among the three groups showed that there was no significant difference in survival rates between the routine dissection group and the extended dissection group(P>0.05).There was a significant difference in survival rates between the non-dissected group and the extended lymph node dissection group(P<0.05).Univariate analysis showed that GA19-9,tumor diameter,portal tumor thrombus,and lymph node dissection were related to prognosis of patients with ICC(P<0.05).Multivariate analysis showed CA19-9,tumor diameter,and extent of lymph nodes clearance were related to patient survival(P<0.05).Conclusions CA19-9,tumor diameter,and extent of lymph node dissection were independent risk factors of survival in patients with ICC.For patients with ICC who undergo surgical resection,conventional laparoscopic lymph node dissection can achieve good results,and there is no need to extend lymph node dissection.
作者
朱明辉
张先舟
韩风
聂常富
Zhu Minghui;Zhang Xianzhou;Han Feng;Nie Changfu(Department of General Surgery,Zhengzhou People'Hospital,Zhengzhou 450008,China;Department of Hepatobiliary and Pancreatic Surgery,Affiliated Cancer Hospital of Zhengzhou University,Zhengzhou 450008,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2020年第1期48-52,共5页
Chinese Journal of Hepatobiliary Surgery
基金
河南省科技攻关项目(162102310045)。
关键词
胆管上皮癌
淋巴结切除术
预后分析
Cholangiocarcinoma
Lymph node excision
Prognosis analysis
作者简介
通信作者:聂常富,Email:ncfchinal970@163.com。
