梅奥分期和TNM分期对肝门胆管癌预后的评估价值及其对比研究

发布时间：2018-03-20 15:47

  本文选题：肝门胆管癌　切入点：梅奥分期　出处：《青岛大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:研究梅奥分期中分层因素在HCCA患者预后中的作用,评价梅奥分期对预后的预测价值。梅奥分期和AJCC的TNM分期系统(第七版)对肝门胆管癌患者生存期的预测价值进行对比研究。方法:收集青岛大学附属医院在2004-02-01至2013-01-01期间治疗的可进行梅奥分期的335例肝门胆管癌患者的临床资料。所有病例随访至2016年9月30日。根据患者的各种临床资料,通过入选标准,对收入本研究的病例进行核对,符合排除标准的予以排除,最终确认研究对象。根据基线资料的定义,收集需要的临床数据。用于梅奥分期的资料主要通过影像学资料获得,而TNM分期的资料主要是根据手术病理结果获得。采用Kaplan-Meier生存曲线和log-rank检验的方法对各个指标进行单因素分析,得到有统计学意义的影响因素。然后将上述影响因素导入Cox回归分析,建立Cox风险比例模型,得到有统计学意义的与预后有关的独立因素。使用Kaplan-Meier生存曲线和log-rank检验分别对两种分期系统与生存期的关系进行相关性分析,并进行系统内部的两两对比,评估分期系统内部的区分度和整体的单一趋势。使用ROC曲线对两种分期系统进行单一趋势性分析,通过其面积,比较其在HCCA患者预后中的评估能力。结果:至2016年9月30日,共283例患者死亡,40例无随访资料或拒绝参加此研究,12例患者删失,删失比例4.1%。中位生存期为12.4个月,1年、2年、3年生存率分别为(51.9±2.9)%,(21.1±2.5)%、(12.6±1.9)%。单因素分析中,认为肿瘤最大直径3cm(P0.001)、白蛋白≥35g/L(P0.001)、肿瘤转移(P0.001)、淋巴结转移(P0.001)、治疗方式(P0.001)、前白蛋白≥200g/L(P=0.015)、ECOG评分(P0.001)、Bismuth-Corlete分型(P0.001)、CA19-9≥1000U/ml(P=0.003)、血管受累(P=0.037)对HCCA的预后有影响。通过COX回归分析,发现肿瘤最大直径3cm(P=0.046)、Bismuth-Corlete分型(P0.001)、肿瘤转移(P=0.004)、治疗方式(P0.001)、白蛋白≥35g/L(P0.001)、ECOG评分(0.001)为预后的独立危险因素。根据Kaplan-Meier生存曲线变化和log-rank检验结果,显示两种分期系统均和患者生存期相关(P0.001),分期级别越晚,预后情况越差。通过分期内部的两两对比,发现梅奥分期内部各分期之间异质性很好,优于TNM分期。对两种系统的预后评估能力进行单一趋势性分析,发现梅奥分期ROC曲线下的面积最大(AUC=0.587),优于TNM分期(AUC=0.501)。结论:基于单中心小样本研究,梅奥分期可用于术前患者预后评估,预测价值优于TNM分期,可以提供较好的分层能力。梅奥分期中的肿瘤转移、肿瘤最大直径3cm和ECOG评分是影响预后的独立因素,而CA19-9≥1000U/ml是否可以作为3期的评估指标,需要进一步的研究。根治性手术切除和提高患者术前白蛋白水平,可明显提高患者预后的生存期。
[Abstract]:Objective: to study the role of stratified factors in Mayo staging in the prognosis of HCCA patients. To evaluate the prognostic value of Mayo staging and AJCC TNM staging system (version 7th) in predicting the survival of patients with hilar cholangiocarcinoma. Clinical data of 335 patients with hilar cholangiocarcinoma treated for Mayo staging up to 2013-01-01. All cases were followed up until September 30th 2016. Through the inclusion criteria, the cases included in this study were checked, excluded according to the exclusion criteria, and the study object was finally confirmed. According to the definition of baseline data, Collect the necessary clinical data. The data used for Mayo's staging are obtained primarily through imaging data, The data of TNM staging were obtained mainly according to the results of operation and pathology. Kaplan-Meier survival curve and log-rank test were used to analyze the single factor of each index. The influencing factors were obtained, and the Cox risk ratio model was established by introducing the above factors into the Cox regression analysis. Kaplan-Meier survival curve and log-rank test were used to analyze the relationship between the two staging systems and survival time respectively, and the internal comparison was made. To evaluate the degree of differentiation within the staging system and the overall single trend. The ROC curve was used to analyze the single trend of the two staging systems, and their area was used to compare their ability to evaluate the prognosis of patients with HCCA. Results: by September 30th 2016, The median survival time was 12.4 months, 1 year, 2 years and 3 years survival rates were 51.9 卤2.9%, 21.1 卤2.5% and 12.6 卤1.9%, respectively. It is considered that the maximum diameter of tumor is 3cm / L P0.001U, albumin 鈮，

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