中国实用外科杂志

中国实用外科杂志

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第8版AJCC分期系统对肝内胆管癌术后预后评估价值研究

杨发才1，薄志远2，李    梦1，段安琪2，沈宁佳2，张永杰2，李敬东1，邱应和2   

  1. 1川北医学院附属医院肝外一科，四川南充617000；2海军军医大学东方肝胆外科医院胆道二科，上海200438
  • 出版日期:2019-11-01 发布日期:2019-11-12

  • Online:2019-11-01 Published:2019-11-12

摘要：

目的    探讨第8版美国癌症联合委员会（AJCC）分期系统对肝内胆管癌（ICC）术后病人预后评估的价值。方法    回顾性分析2013年1月至2018年12月海军军医大学东方肝胆外科医院收治的155例行根治性切除术后ICC病人的临床及病理资料，所有病人均根据第8版AJCC分期系统进行分期，采用Kaplan-Meier法进行生存分析，采用COX比例风险模型进行多因素分析，用受试者工作特征曲线（ROC曲线）和曲线下面积（AUC）判断分期系统对预后的评估能力。结果    （1）155例病人随访率为70.3%，中位随访时间为26（1～67）个月，术后病人1、3、5年存活率分别为81%、39%、25%。（2）T1a、T1b、T2、T3、T4期的中位生存时间分别是45.5、28.8、19.1、18.9、16.2个月（P<0.001）；N0、N1期的中位生存时间分别为33.4、15.8个月（P<0.001）；ⅠA、ⅠB、Ⅱ、ⅢA、ⅢB期的中位生存时间分别是46.8、32.3、21.6、20.3、15.6个月（P<0.001）。T分期、N分期和TNM分期的ROC曲线分析AUC分别为0.704、0.718、0.698。（3）单因素分析提示CA19-9、肿瘤数目、血管侵犯、术中输血、T分期、N分期和TNM分期是ICC病人预后的危险因素（P<0.05）；多因素分析提示肿瘤数目、术中输血、N分期是ICC病人预后的独立危险因素（P<0.05）。结论    第8版AJCC分期系统对ICC术后预后评估具有一定的价值。多发肿瘤、术中输血、N分期是ICC病人的独立预后因素。

关键词: 肝内胆管癌, 美国癌症联合委员会分期系统, 预后评估, 危险因素

Abstract:

Study on the value of the eighth edition of AJCC staging system in evaluating the prognosis of patients with intrahepatic cholangiocarcinoma after radical resection        YANG Fa-cai*，BO Zhi-yuan，LI Meng，et al. *Department of Hepatology，Affiliated Hospital of North Sichuan Medical College，Nanchong 617000，China
Corresponding authors：QIU Ying-he，E-mail：Qiuyinghe@aliyun.com；LI Jing-dong，E-mail：lijingdong358@126.com
        YANG Fa-cai and BO Zhi-yuan are the first authors who contributed equally to the article
Abstract    Objective    To explore the value of the 8th edition of the AJCC staging system in evaluating the prognosis of patients with intrahepatic cholangiocarcinoma (ICC) after operation. Methods    A total of 155 patients with ICC after radical resection in Eastern Hepatobiliary Surgery Hospital,Naval Military Medical University from January 2013 to December 2018 were analyzed retrospectively．All patients were staged according to the 8th edition of the AJCC staging system. The survival rates were estimated using Kaplan-Meier methods．Multivariate analysis was assessed by Cox proportional hazards regression analysis．The predictive ability of staging systems was evaluated by receiver operating characteristic curve (ROC) and area under curve (AUC). Results    (1) The follow-up rate of 155 patients was 70.3%, and the median follow-up time was 26 (1-67) months . The 1-, 3-, and 5-year survival rates of patients after surgery were 81%, 39%, and 25%, respectively. (2) The median survival time of T1a, T1b, T2, T3, and T4 stages was 45.5, 28.8, 19.1, 18.9 and 16.2 months, respectively (P<0.001); The median survival time of N0 and N1 stages was 33.4 and 15.8 months, respectively (P<0.001); The median survival time of IA, IB, Ⅱ, ⅢA and ⅢB stages was 46.8, 32.3, 21.6, 20.3 and 15.6 months, respectively (P< 0.001). The ROC curve analysis of T stage, N stage and TNM stage indicated that the AUC were 0.704, 0.718 and 0.698, respectively. (3) Univariate analysis indicated that CA19-9, tumor number, vascular invasion, intraoperative blood transfusion, T stage, N stage and TNM stage were risk factors for prognosis in patients with ICC (P<0.05). Multivariate analysis indicated that the number of tumors, intraoperative blood transfusion, and N stage were independent risk factors for prognosis in patients with ICC (P<0.05). Conclusion     The 8th edition of the AJCC staging system is of certain value in the evaluation of postoperative prognosis of intrahepatic cholangiocarcinoma. Multiple tumors, intraoperative blood transfusion and N stage are independent prognostic factors for ICC patients.

Key words: intrahepatic cholangiocarcinoma, AJCC staging system, prognosis assessment, risk factor