切缘大小对肝内胆管结石相关性肝内胆管细胞癌患者预后的影响
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摘要
目的探讨切缘大小对肝内胆管结石相关性肝内胆管细胞癌(ICC)患者预后的影响。方法将我院65例肝内胆管结石相关性ICC患者根据切缘大小分为宽切缘组(n=36)和窄切缘组(n=29)。分析比较两组患者的一般资料及临床病理资料,应用Kaplan-Meier法进行生存分析,采用Cox回归分析预后的影响因素。结果两组患者肿瘤数目、肿瘤直径及邻近器官侵犯比较,差异具有统计学意义(P<0.05);宽切缘组患者的总生存期优于窄切缘组,差异具有统计学意义(P<0.05);多因素Cox回归分析显示,肿瘤直径、TNM分期、微血管侵犯、邻近器官侵犯、淋巴结转移及切缘大小是影响肝内胆管结石相关性ICC患者术后生存期的独立危险因素(P<0.05)。结论行宽切缘手术的肝内胆管结石相关性ICC患者的预后优于窄切缘者。
Objective To investigate the effect of incision margin size on the prognosis of patients with intrahepatic cholangiocarcinoma(ICC) associated with intrahepatic bile duct stones. Methods A total of 65 ICC patients with intrahepatic bile duct stones in our hospital were divided into wide incision margin group(n=36) and narrow incision margin group(n=29)according to the size of incision margin. The general data and clinicopathological data of the two groups were analyzed and compared. Survival analysis was carried out by Kaplan-Meier method and prognostic factors were analyzed by Cox regression.Results There were significant differences in the number of tumors, the diameter of tumors and the invasion of adjacent organs between the two groups(P<0.05). The total survival time of the wide incision margin group was better than that of the narrow incision margin group(P<0.05). Multivariate Cox regression analysis showed that tumor diameter, TNM stage, microvascular invasion, invasion of adjacent organs, lymph node metastasis and margin size were independent risk factors affecting the survival of ICC patients with intrahepatic bile duct stones(P<0.05). Conclusion The prognosis of ICC patients with intrahepatic bile duct stones undergoing wide incision margin surgery is better than that of patients undergoing narrow incision margin surgery.
Objective To investigate the effect of incision margin size on the prognosis of patients with intrahepatic cholangiocarcinoma(ICC) associated with intrahepatic bile duct stones. Methods A total of 65 ICC patients with intrahepatic bile duct stones in our hospital were divided into wide incision margin group(n=36) and narrow incision margin group(n=29)according to the size of incision margin. The general data and clinicopathological data of the two groups were analyzed and compared. Survival analysis was carried out by Kaplan-Meier method and prognostic factors were analyzed by Cox regression.Results There were significant differences in the number of tumors, the diameter of tumors and the invasion of adjacent organs between the two groups(P<0.05). The total survival time of the wide incision margin group was better than that of the narrow incision margin group(P<0.05). Multivariate Cox regression analysis showed that tumor diameter, TNM stage, microvascular invasion, invasion of adjacent organs, lymph node metastasis and margin size were independent risk factors affecting the survival of ICC patients with intrahepatic bile duct stones(P<0.05). Conclusion The prognosis of ICC patients with intrahepatic bile duct stones undergoing wide incision margin surgery is better than that of patients undergoing narrow incision margin surgery.
引文
[1] DONG LQ,SHI Y,MA LJ,et al.Spatial and temporal clonal evolution of intrahepatic cholangiocarcinoma[J].J Hepatol,2018,69(1):89-98.
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[4]刘驰,杨启,秦长岭.微血管侵犯对早期肝癌肝切除术切缘选择及患者预后的影响[J].肝胆外科杂志,2017,25(5):353-357.
[5]邓周峰,施宝民.肝内胆管癌合并肝内胆管结石的病理特征及预后危险因素研究[J].医学临床研究,2016,33(12):2409-2412.
[6]柳志,陈勇治,舒健,等.膜联蛋白A2、上皮细胞钙黏蛋白及波形蛋白在肝内胆管结石相关肝内胆管癌中的表达及意义[J].中国普通外科杂志,2017,26(2):190-198.
[7] TANG H,LU W,LI B,et al.Influence of surgical margins on overall survival after resection of intrahepatic cholangiocarcinoma:a metaanalysis[J].Medicine,2016,95(35):e4621.
[8]王翊凯,毕新宇,李智宇,等.肝细胞癌术后预后新型评分系统的建立[J].中华肿瘤杂志,2017,39(12):903-909.
[9] DE JONG MC,NATHAN H,SOTIROPOULOS GC,et al.Intrahepatic cholangiocarcinoma:an international multi-institutional analysis of prognostic factors and lymph node assessment[J].J Clin Oncol,2011,29(23):3140-3145.
[2]周华邦,徐勤蓉,汪慧,等.肝内胆管细胞癌的危险因素分析[J].中华肝脏病杂志,2009,17(12):935-939.
[3]魏妙艳,吕立升,汤朝晖,等.肝内胆管结石合并肝内胆管癌的研究进展[J].中华肝脏外科手术学电子杂志,2016,5(4):201-205.
[4]刘驰,杨启,秦长岭.微血管侵犯对早期肝癌肝切除术切缘选择及患者预后的影响[J].肝胆外科杂志,2017,25(5):353-357.
[5]邓周峰,施宝民.肝内胆管癌合并肝内胆管结石的病理特征及预后危险因素研究[J].医学临床研究,2016,33(12):2409-2412.
[6]柳志,陈勇治,舒健,等.膜联蛋白A2、上皮细胞钙黏蛋白及波形蛋白在肝内胆管结石相关肝内胆管癌中的表达及意义[J].中国普通外科杂志,2017,26(2):190-198.
[7] TANG H,LU W,LI B,et al.Influence of surgical margins on overall survival after resection of intrahepatic cholangiocarcinoma:a metaanalysis[J].Medicine,2016,95(35):e4621.
[8]王翊凯,毕新宇,李智宇,等.肝细胞癌术后预后新型评分系统的建立[J].中华肿瘤杂志,2017,39(12):903-909.
[9] DE JONG MC,NATHAN H,SOTIROPOULOS GC,et al.Intrahepatic cholangiocarcinoma:an international multi-institutional analysis of prognostic factors and lymph node assessment[J].J Clin Oncol,2011,29(23):3140-3145.