乙肝相关性肝内胆管细胞癌临床病理特点及其预后

发布时间：2018-06-20 16:18

本文选题：乙型肝炎病毒 + 肝内胆管细胞癌　；参考：《第二军医大学》2013年硕士论文

【摘要】：研究背景：近年来，全球肝内胆管细胞癌（intrahepatic cholangiocarcinoma ICC）的发病率有明显上升的趋势。然而其病因目前仍不明确。最近研究提示乙型肝炎病毒（hepatitis B virus HBV）感染是ICC的危险因素之一，且乙肝相关性ICC与乙肝相关性肝细胞癌（hepatocellular carcinoma HCC）具有相同致病过程，建议将乙肝相关性ICC与无合并慢性HBV感染的ICC患者区分开。然而乙肝相关性ICC是否具有不同的临床病理特点仍不详。由于ICC较低的发病率及手术切除率，影响其根治性切除术后预后的研究也很少。因此本研究的目的为探讨乙肝相关性ICC患者的临床病理特点及影响其根治性切除术后预后的危险因素。研究方法：回顾性分析了2005年1月至2006年12月在东方肝胆外科医院接受手术的ICC患者的临床病理资料及其预后。并根据是否合并有慢性HBV感染进行分组比较。采用卡方检验对各样本率之间进行比较，Kaplan-Meier法对确定的单因素进行生存率分析， Logistic回归进行多因素分析，生存率差异的显著性检验用Log-rank检验。结果：乙肝相关性ICC患者的发病年龄较没有合并慢性HBV感染的患者年轻。与无合并慢性HBV感染的患者相比，乙肝相关性ICC患者术前血浆甲胎蛋白（AFP）值异常升高的比例较高，但术前血浆糖抗原19-9（CA19-9）、r-谷氨酰转肽酶（r-GT）、碱性磷酸酶（ALP）异常升高的比例较低。术后标本病理检查提示乙肝相关性ICC患者病理标本大体分型多为肿块型，且肿瘤组织低分化程度比例及肝周淋巴结转移率均较低。与无合并慢性HBV感染的患者相比，乙肝相关性ICC患者有较高的术后生存率。乙肝相关性ICC患者根治性切除的1、3、5年生存率分别为60%、18%、13%。多因素分析显示肝硬化（危险系数[HR]1.875,95%可信区间[95%CI]1.197-3.278, P=0.008）及肝多发肿瘤（HR2.653,95%CI1.562-4.508, P0.001）是影响根治性切除术后总生存率的独立预后危险因素，而肝硬化（HR1.919,P=0.012）、肿瘤血管侵犯（HR3.779, P=0.02）及TNM分期晚期（III or IV期）（HR2.027, P 0.001）为影响根治性切除术后无瘤生存的独立预后危险因素。结论：乙肝相关性ICC与无合并慢性HBV感染的ICC患者相比具有不同的临床病理特点。乙肝相关性ICC患者的发病年龄早，易引起血清AFP升高，病理标本大体分型多为肿块型，，且具有较高的术后生存率，预后好。临床上需将其与无合并慢性HBV感染的患者区分开。肝硬化、肿瘤血管侵犯及TNM分期晚期（III or IV期）为影响乙肝相关性ICC患者根治性切除术后无瘤生存的独立预后危险因素，而肝硬化及肝多发肿瘤为影响其根治性切除术后总生存率的独立危险因素。
[Abstract]:Background: in recent years, the incidence of intrahepatic cholangiocarcinoma in intrahepatic cholangiocarcinoma has been increasing. However, the etiology is still unclear. Recent studies suggest that hepatitis B virus infection is one of the risk factors of virus, and HBC-associated carcinoma has the same pathogenicity as HBC-associated hepatocellular carcinoma. It is suggested to distinguish hepatitis B associated ICC from those without chronic HBV infection. However, it is unclear whether ICC has different clinicopathological features. Because of the low incidence of ICC and surgical resection rate, there are few studies on the prognosis of ICC after radical resection. The purpose of this study was to investigate the clinicopathological features of patients with hepatitis B associated ICC and the risk factors affecting their prognosis after radical resection. Methods: the clinicopathological data and prognosis of ICC patients who underwent surgery in Oriental Hepatobiliary surgery Hospital from January 2005 to December 2006 were retrospectively analyzed. The patients were divided into groups according to whether they had chronic HBV infection or not. Kaplan-Meier method was used to analyze the survival rate of single factor. Logistic regression was used for multivariate analysis and Log-rank test was used to test the significance of the difference of survival rate. Results: the age of hepatitis B associated ICC patients was younger than that of patients without chronic HBV infection. Compared with those without chronic HBV infection, the rate of abnormal increase of plasma AFP level was higher in patients with hepatitis B associated ICC before operation, but the rate of abnormal elevation of plasma glucose antigen 19-9 (CA19-9) and alkaline phosphatase (ALPP) was lower than that in patients without chronic HBV infection. The pathological examination of postoperative specimens showed that the pathological types of ICC patients with hepatitis B were mostly mass type, and the proportion of low differentiation degree of tumor tissue and the rate of lymph node metastasis around liver were lower. Hepatitis B associated ICC patients had higher postoperative survival rates than those without chronic HBV infection. The 3-year and 5-year survival rates of patients with hepatitis B associated ICC were 60 and 1813 respectively. Multivariate analysis showed that cirrhosis (95 CI 1.197-3.278, P < 0.008) and CI 1.562-4.508 (P 0.001) were independent prognostic factors for overall survival after radical resection. However, HR1.919 / Pu 0.012, tumor vascular invasion HR3.779, P0. 02) and TNM stage III or IV HR2.027, P 0.001 were independent prognostic risk factors for tumor-free survival after radical resection. Conclusion: hepatitis B associated ICC has different clinicopathological features compared with those without chronic HBV infection. The patients with ICC associated with hepatitis B have earlier onset age, higher serum AFP level, higher survival rate and better prognosis. It should be distinguished clinically from patients without chronic HBV infection. Cirrhosis, tumor vascular invasion and advanced TNM stage III or IV were independent prognostic risk factors for the survival of patients with hepatitis B related ICC after radical resection. Cirrhosis and multiple hepatic tumors were independent risk factors for overall survival after radical resection.
【学位授予单位】：第二军医大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R512.62;R735.7

【相似文献】