摘要
目的分析肝内胆管癌(ICC)病人肝切除术后'教科书式结局'(TO)的影响因素,构建预测TO评分模型。方法回顾性分析2011年1月至2017年1月东南大学附属中大医院和中国人民解放军东部战区总医院八一医院收治的261例行肝切除术的ICC病人临床病理资料,分析影响TO的独立危险因素,根据危险因素的权重构建预测TO的评分模型。结果 261例ICC病人中,67例(25.7%)术后发生TO。年龄、肝硬化、手术时间和T分期[第8版美国癌症联合委员会(AJCC)癌症分期]为术后TO的独立预测因素。依此4项因素构建的评分模型显示了较好的预测准确性,最佳截断值为-1.9分,其敏感度为67.2%,特异度为62.9%。一致性检验显示其预测概率和实际发生概率有着较好的一致性(χ~2=1.350,P=0.853)。结论基于年龄、肝硬化、手术时间、T分期4个因素建立的评分模型可较准确地预测ICC病人术后TO的可能性,即手术时间短、无肝硬化、肿瘤直径<5 cm的年轻ICC病人肝切除后获得TO的可能性更大。
Objective To determine the risk factors and develop a risk score model for the textbook outcome(TO)among patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma(ICC).Methods Theclinicopathological data of 261 ICC patients between January 2011 and January 2017 in Zhongda Hospital of SoutheastUniversity and No.81 Hospital of PLA undergoing partial hepatectomy were retrospectively collected.Logistic regressionanalyses were performed to determine the significant risk factors for predicting TO.Results A total of 261 patientsundergoing curative-intent resection of ICC were enrolled in the study.Among them,TO was achieved in 67 patients(25.7%).A multivariable logistic regression analysis indicated that older age,non-cirrhosis,reduced operative duration,and T1 a stage disease were independently associated with achieving a TO.A risk score to assess the probability of TOwas developed according the above four risk factors and had good accuracy and satisfactory calibration(χ~2=1.350,P=0.853).Conclusion Younger ICC patients with short operation duration,no cirrhosis,and tumor diameter<5 cm mayhave the higher probability to achieve TO.The risk score model could accurately predict postoperative TO of patientswith ICC.
作者
雷正清
司安锋
杨平华
张齐
郭光猛
王轩
周家华
程张军
LEI Zheng-qing;SI An-feng;YANG Ping-hua;CHENG Zhang-jun(Hepato-pancreatobiliary Center,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China)
出处
《中国实用外科杂志》
CSCD
北大核心
2019年第10期1071-1076,共6页
Chinese Journal of Practical Surgery
基金
国家自然科学基金面上项目（No.81871988）
江苏省自然科学基金面上项目（No.BK20161441）
江苏省“六大人才高峰”高层次人才培养资助计划（No.SWYY-007)
关键词
肝内胆管癌
肝切除术
教科书式结局
影响因素
评分模型
intrahepatic cholangiocarcinoma
hepatectomy
textbook outcome
influencing factors
risk score
作者简介
通信作者:程张军,E-mail:chengzhangjun@seu.edu.cn
