中国实用外科杂志

中国实用外科杂志

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肝内胆管癌肝切除术后“教科书式结局”影响因素分析及预测模型建立

雷正清1a，司安锋2，杨平华3，张    齐1b，郭光猛1a，王    轩2，周家华1a，程张军1a   

  1. 1 东南大学附属中大医院  a.肝胆胰中心  b.介入与血管中心，江苏南京 210009；2 中国人民解放军东部战区总医院八一医院肿瘤外科，江苏南京 210002；3 海军军医大学东方肝胆外科医院肝外六科，上海 200433
  • 出版日期:2019-10-01 发布日期:2019-10-10

  • Online:2019-10-01 Published:2019-10-10

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（χ2=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。

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

Abstract:

A predictive risk score model of textbook outcome for patients undergoing curative-intent resection of intrahepatic cholangiocarcinoma        LEI Zheng-qing*，SI An-feng，YANG Ping-hua，et al. *Hepato-pancreato-biliary Center，Zhongda Hospital，School of Medicine，Southeast University，Nanjing 210009，China
Corresponding author：CHENG Zhang-jun，E-mail: chengzhangjun@seu.edu.cn
Abstract    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    The clinicopathological data of 261 ICC patients between January 2011 and January 2017 in Zhongda Hospital of Southeast University and No.81Hospital of PLA undergoing partial hepatectomy were retrospectively collected. Logistic regression analyses were performed to determine the significant risk factors for predicting TO. Results    A total of 261 patients undergoing 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 T1a stage disease were independently associated with achieving a TO. A risk score to assess the probability of TO was developed according the above four risk factors and had good accuracy and satisfactory calibration(χ2=1.350，P=0.853). Conclusion    Younger ICC patients with short operation duration，no cirrhosis，and tumor diameter <5 cm may have the higher probability to achieve TO. The risk score model could accurately predict postoperative TO of patients with ICC.

Key words: intrahepatic cholangiocarcinoma, hepatectomy, textbook outcome, influencing factors, risk score