摘要
目的探讨癌旁微转移灶(PTMM)及其他临床和病理学特征对肝内胆管癌(ICC)根治性切除术后患者预后的影响。方法采用回顾性队列研究方法。回顾性分析2017年1月至2022年12月在复旦大学附属华山医院普外科肝胆外科中心接受根治性切除的137例ICC患者资料。男性91例, 女性46例, 年龄[M(IQR)]63(13)岁(范围:32~82岁)。采用Kaplan-Meier曲线估计中位生存时间, Log-rank检验评估总体生存和无复发生存的差异, 单因素和多因素Cox回归模型确定总体生存和无复发生存的影响因素。结果 137例ICC患者的中位总体生存时间为34个月, 1、2、3年总体生存率分别为90.7%、69.4%、39.5%。单因素和多因素Cox分析结果显示, Child-Pugh分级、CA19-9、癌胚抗原、PTMM为ICC患者根治性切除术后总体生存的独立预后因素(P值均<0.05)。Child-Pugh分级、肿瘤最大径、是否淋巴结转移、PTMM为ICC患者根治切除术后无复发生存的独立预后因素(P值均<0.05)。PTMM阳性患者的中位总体生存时间为21个月, 中位无复发生存时间为12个月;而PTMM阴性患者的中位总体生存时间超过60个月, 中位无复发生存时间为36个月。Log-rank检验结果显示, PTMM阳性患者与阴性患者总体生存和无复发生存的差异均有统计学意义(P<0.01, P=0.001)。结论初步研究结果提示, PTMM在ICC患者预后评估中有重要参考价值。
Objective:To investigate the impact of para-tumoral micro-metastasis(PTMM)and other clinicopathological characteristics on the prognosis of patients with intrahepatic cholangiocarcinoma(ICC).Methods:This is a retrospective cohort study.Clinical data from 137 ICC patients who underwent radical resection at the Hepatobiliary Surgery Center,Department of General Surgery,Huashan Hospital,Fudan University,between January 2017 and December 2022 were analyzed retrospectively.The cohort included 91 males and 46 females,with age(M(IQR))of 63(13)years(range:32 to 82 years).Kaplan-Meier curves were used to estimate median survival times,while Log-rank tests assessed differences in overall survival(OS)and recurrence-free survival(RFS).Univariate and multivariate Cox regression models were employed to identify factors associated with OS and RFS.Results:The median OS for all 137 ICC patients was 34 months,with 1-,2-,and 3-year OS rates of 90.7%,69.4%,and 39.5%,respectively.The results of univariate and multivariate Cox analysis showed that Child-Pugh grade,CA19-9,carcinoembryonic antigen,and PTMM were independent prognostic factors for OS in ICC patients after radical resection(all P<0.05),Child-Pugh grade,maximum tumor diameter,whether lymph node metastasis,and PTMM were independent prognostic factors for RFS in radical resection in ICC patients(all P<0.05).PTMM-positive patients had a median OS of 21 months and median RFS of 12 months,whereas PTMM-negative patients exhibited a median OS exceeding 60 months and median RFS of 36 months.Log-rank tests demonstrated statistically significant differences in OS and RFS between PTMM-positive and PTMM-negative patients(P<0.01 and P=0.001,respectively).Conclusion:Preliminary findings suggest that PTMM holds significant prognostic value in evaluating outcomes for ICC patients undergoing curative resection.
作者
王超群
孙豪庭
刘晓佳
朱柏伦
罗金同
陆录
殷保兵
Wang Chaoqun;Sun Haoting;Liu Xiaojia;Zhu Bolun;Luo Jintong;Lu Lu;Yin Baobing(Hepatobiliary Surgery Center,Department of General Surgery,Huashan Hospital,Fudan University,Shanghai 200040,China;Department of Pathology,Huashan Hospital,Fudan University,Shanghai 200040,China)
出处
《中华外科杂志》
北大核心
2025年第6期523-528,共6页
Chinese Journal of Surgery
基金
国家自然科学基金(81702857, 82373017)。
关键词
胆道肿瘤
外科手术
肝内胆管癌
癌旁微转移灶
预后
复发
预测
Biliary tract neoplasms
Surgical procedures,operative
Intrahepatic cholangiocarcinoma
Para-tumoral micro-metastasis
Prognosis
Recurrence
Prediction
