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山东大学学报 (医学版) ›› 2021, Vol. 59 ›› Issue (4): 93-99.doi: 10.6040/j.issn.1671-7554.0.2020.1548

• 临床医学 • 上一篇    下一篇

肝内胆管癌根治性切除术后生存因素分析及列线图的建立

谢同辉,陈志强,常建华,赵丹文,徐博文,智绪亭   

  1. 山东大学齐鲁医院肝胆外科, 山东 济南 250012
  • 发布日期:2021-04-30
  • 通讯作者: 智绪亭. E-mail:zhixuting@hotmail.com

Analysis of prognostic factors after radical resection of intrahepatic cholangiocarcinoma and establishment of a nomogram

XIE Tonghui, CHEN Zhiqiang, CHANG Jianhua, ZHAO Danwen, XU Bowen, ZHI Xuting   

  1. Department of Hepatobiliary Surgery, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250012, Shandong, China
  • Published:2021-04-30

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摘要： 目的 探讨肝内胆管癌(ICC)根治性切除术后生存影响因素,个体化建立列线图预测术后总生存时间。 方法 搜集2009年7月至2017年10月于我院行根治性手术的79例ICC患者的临床及病理资料,Kaplan-Meier和Cox回归模型用于分析临床及病理特征对术后总体生存率和无复发生存率的影响,通过R软件(版本号4.0.1)建立生存列线图,并使用一致性指数、校准曲线及ROC曲线下面积(AUC)验证列线图的预测效能。 结果 79例患者术后第1、2、3年累积无复发生存率分别为43.0%、26.6%、20.3%,中位生存期为15个月,79例患者术后第1、2、3年累积总生存率分别为63.3%、41.8%、27.8%。多因素分析显示CA19-9、脉管癌栓、肿瘤数目是影响患者生存的独立危险因素。CA19-9、肿瘤数目、病理分化程度是影响复发的独立危险因素。一致性指数为0.723(95%CI:0.66~0.79),第1、2、3年生存率的AUC分别为0.78(95%CI:0.68~0.89)、0.85(95%CI:0.77~0.93)、0.77(95%CI:0.67~0.87)。 结论 ICC预后较差,早期症状不典型,术后生存率低,CA19-9、肿瘤数目是影响生存和复发的共同独立危险因素。经内部验证的列线图对术后患者的生存率有较好的预测能力。

关键词: 肝内胆管癌, 生存分析, 预后因素, 列线图, 复发

Abstract: Objective To explore the prognostic factors after radical resection of intrahepatic cholangiocarcinoma(ICC)and to establish a nomogram to predict postoperative overall survival. Methods The clinicopathological data of 79 ICC patients who underwent radical resection in our hospital during Jul. 2009 and Oct. 2017 were collected. The impacts of clinicopathological characteristics on overall survival and recurrence-free survival were analyzed with Kaplan-Meier and Cox regression models. A survival nomogram was established with R software(version 4.0.1), and the predictive performance of the nomogram was verified with C-index, calibration curve and area under ROC curve(AUC). Results The 1-year, 2-year, and 3-year cumulative recurrence-free survival rates were 43.0%, 26.6% and 20.3%, respectively. The median survival time was 15 months, and the 1-year, 2-year, and 3-year cumulative overall survival rates were 63.3%, 41.8% and 27.8%, respectively. Multivariate analysis demonstrated that CA19-9, lymphovascular invasion and multiple tumors were independent risk factors of overall survival. CA19-9, multiple tumors and differentiation of tumors were independent risk factors of recurrence. The C-index was 0.723(95%CI: 0.66-0.79), and the AUC of 1-year, 2-year, and 3-year survival rates were 0.78(95%CI: 0.68-0.89), 0.85(95%CI: 0.77-0.93), and 0.77(95%CI: 0.67-0.87), respectively. Conclusion ICC has a poor prognosis and low postoperative survival rate. The early symptoms are atypical. CA19-9 and multiple tumors are independent risk factors for both survival and recurrence. The internally validated nomogram can predict the survival rates.

Key words: Intrahepatic cholangiocarcinoma, Survival analysis, Prognostic factors, Nomogram, Recurrence

中图分类号: 

  • R735.8
[1] Gupta A, Dixon E. Epidemiology and risk factors: intrahepatic cholangiocarcinoma[J]. Hepatobiliary Surg Nutr, 2017, 6(2): 101-104.
[2] Zhang H, Yang T, Wu M, et al. Intrahepatic cholangiocarcinoma: Epidemiology, risk factors, diagnosis and surgical management[J]. Cancer Lett, 2016, 379(2): 198-205.
[3] Chun Y, Javle M. Systemic and adjuvant therapies for intrahepatic cholangiocarcinoma[J]. Cancer Control, 2017, 24(3): 1-7.
[4] Rahnemai-Azar A, Weisbrod A, Dillhoff M, et al. Intrahepatic cholangiocarcinoma: current management and emerging therapies[J]. Expert Rev Gastroenterol Hepatol, 2017, 11(5): 439-449.
[5] 刘连新, 尹大龙. 肝内胆管癌多学科综合治疗优化选择[J]. 中国实用外科杂志, 2020, 40(6): 680-684. LIU Xinlian, YIN Dalong. Optimal management of multidisciplinary treatment for intrahepatic chaolangiocarcinoma[J]. Chinese Journal of Practical Surgery, 2020, 40(6): 680-684.
[6] Mavros M, Economopoulos K, Alexiou V, et al. Treatment and prognosis for patients with intrahepatic cholangiocarcinoma: systematic review and meta-analysis[J]. JAMA Surgery, 2014, 149(6): 565-574.
[7] Van Dyke A, Shiels M, Jones G, et al. Biliary tract cancer incidence and trends in the United States by demographic group, 1999-2013[J]. Cancer, 2019, 125(9): 1489-1498.
[8] de Jong M, Nathan H, Sotiropoulos G, 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.
[9] Ejaz A, Cloyd J, Pawlik T. Advances in the diagnosis and treatment of patients with intrahepatic cholangiocarcinoma[J]. Ann Surg Oncol, 2020, 27(2): 552-560.
[10] Nathan H, Pawlik T, Wolfgang C, et al. Trends in survival after surgery for cholangiocarcinoma: a 30-year population-based SEER database analysis[J]. J Gastrointest Surg, 2007, 11(11): 1488-1496; discussion 1496-1497.
[11] Ribero D, Pinna A, Guglielmi A, et al. Surgical approach for long-term srvival of patients with intrahepatic cholangiocarcinoma: a multi-institutional analysis of 434 patients[J]. Arch Surg, 2012, 147(12): 1107-1113.
[12] Nathan H, Aloia T, Vauthey J, et al. A proposed staging system for intrahepatic cholangiocarcinoma[J]. Ann Surg Oncol, 2009, 16(1): 14-22.
[13] Spolverato G, Vitale A, Cucchetti A, et al. Can hepatic resection provide a long-term cure for patients with intrahepatic cholangiocarcinoma?[J]. Cancer, 2015, 121(22): 3998-4006.
[14] Chan K, Tsai C, Yeh C, et al. Characterization of intrahepatic cholangiocarcinoma after curative resection: outcome, prognostic factor, and recurrence[J]. BMC Gastroenterol, 2018, 18(1): 180.
[15] 季鸿翔, 司马辉, 匡悦, 等. 肝内胆管癌根治性切除术中淋巴结清扫价值研究[J]. 中国实用外科杂志, 2020, 40(6): 703-709. JI Hongxiang, SI Mahui, KUANG Yue, et al. Significance of lymphadenectomy in intrahepatic cholangiocarcinoma with radical resection[J]. Chinese Journal of Practical Surgery, 2020, 40(6): 703-709.
[16] Spolverato G, Ejaz A, Kim Y, et al. Tumor size predicts vascular invasion and histologic grade among patients undergoing resection of intrahepatic cholangiocarcinoma[J]. J Gastrointest Surg, 2014, 18(7): 1284-1291.
[17] Koprowski H, Steplewski Z, Mitchell K, et al. Colorectal carcinoma antigens detected by hybridoma antibodies[J]. Somatic cell genetics, 1979, 5(6): 957-971.
[18] Liang B, Zhong L, He Q, et al. Diagnostic accuracy of serum CA19-9 in patients with cholangiocarcinoma: a systematic review and meta-analysis[J]. Med Sci Monit, 2015, 21: 3555-3563. doi: 10.12659/msm.895040.
[19] Yamada T, Nakanishi Y, Okamura K, et al. Impact of serum carbohydrate antigen 19-9 level on prognosis and prediction of lymph node metastasis in patients with intrahepatic cholangiocarcinoma[J]. J Gastroenterol Hepatol, 2018, 33(9): 1626-1633.
[20] Bergquist J, Ivanics T, Storlie C, et al. Implications of CA19-9 elevation for survival, staging, and treatment sequencing in intrahepatic cholangiocarcinoma: A national cohort analysis[J]. J Surg Oncol, 2016, 114(4): 475-482.
[21] Yang H, Wang J, Li Z, et al. Risk factors and outcomes of early relapse after curative resection of intrahepatic cholangiocarcinoma[J]. Front Oncol, 2019, 9: 854. doi: 10.3389/fonc.2019.00854.
[22] Addeo P, Jedidi I, Locicero A, et al. Prognostic impact of tumor multinodularity in intrahepatic cholangiocarcinoma[J]. J Gastrointest Surg, 2019, 23(9): 1801-1809.
[23] Hyder O, Marques H, Pulitano C, et al. A nomogram to predict long-term survival after resection for intrahepatic cholangiocarcinoma: an Eastern and Western experience[J]. JAMA Surgery, 2014, 149(5): 432-438.
[24] Okubo S, Mitsunaga S, Kato Y, et al. The prognostic impact of differentiation at the invasive front of biliary tract cancer[J]. J Surg Oncol, 2018, 117(6): 1278-1287.
[25] Wang Y, Li J, Xia Y, et al. Prognostic nomogram for intrahepatic cholangiocarcinoma after partial hepatectomy[J]. J Clin Oncol, 2013, 31(9): 1188-1195.
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