肝门部胆管癌根治术后复发高危因素研究
发布时间：2018-09-13 16:18
【摘要】：背景： 肝门部胆管癌(Perihilar cholangiocarcinoma, PHC)是指发生于胆囊管开口以上的肝总管和左右肝管的胆道黏膜上皮癌,预后较差。手术切除是本病治愈的唯一机会和主要的治疗手段。但是根治性手术切除后仍有40-60%的患者发生复发或远处转移,并且大部分为一年内的早期复发。对于可切除的肝门部胆管癌,建立术前和术后治疗策略的重点是明确预后高危因素。本研究的目标便是探索可预测肝门部胆管癌根治术后复发的高危因素,并根据高危因素,初步建立一个可预测早期复发的评分模型。 方法： 该研究包括了从2011年5月至2014年5月共66例行肝门部胆管癌根治术后的病人。分析其临床病理特征与无复发生存期(Recurrence Free Survival Time)的相关性。分析方法中单因素分析为Kaplan-Meier分析和对数秩检验(log-rank test),多因素分析为Cox风险回归模型和二元Logistic回归分析(是否早期复发)。 结果： 病理分级(HR:1.86, P=0.03)、淋巴结转移(HR：4,P0.01)、肿瘤病理T分期(HR:1.68, P=0.04)、术前CA19-9水平(HR：2.17,P=0.01)、术后γ-GT水平(HR:2.06, P=0.02)被证明为根治术后复发的独立高危因素。术前CA19-9水平的最佳切点值为1000U/ml,术后γ-GT水平的最佳切点值为100U/l。1年内早期复发的预测模型：ER评分=2.3*病理分化(中/低分化：1分,高分化：0分)+2.9*病理T分期(T3/T4：1分,T1/T2：0分)+3.1*淋巴结(局部转移：1分,无转移：0分)-5.7。术后1年内早期复发的概率为1/[1+EXP(-ER评分)]。 结论： 病理分级、淋巴结转移、肿瘤病理T分期、术前CA19-9水平、术后γ-GT水平可预测肝门部胆管癌根治术后患者的预后,有助于建立新的术前(腹腔镜探查和/或新辅助治疗)和术后(预防性辅助化疗)治疗策略。
[Abstract]:Background: hilar cholangiocarcinoma (Perihilar cholangiocarcinoma, PHC) refers to the mucosal epithelial carcinoma of the common hepatic duct and the left and right hepatic ducts that occur above the opening of the gallbladder duct, and the prognosis is poor. Surgical resection is the only chance and main treatment of the disease. However, 40-60% of the patients still had recurrence or distant metastasis after radical resection, most of which were early recurrence within one year. For resectable hilar cholangiocarcinoma, the key to establish preoperative and postoperative treatment strategies is to identify prognostic risk factors. The objective of this study was to explore the risk factors for predicting recurrence of hilar cholangiocarcinoma after radical resection, and to establish a scoring model for predicting early recurrence according to the high risk factors. Methods: the study included 66 patients who underwent radical resection of hilar cholangiocarcinoma from May 2011 to May 2014. To analyze the correlation between clinicopathological features and recurrence free survival (Recurrence Free Survival Time). Univariate analysis included Kaplan-Meier analysis and logarithmic rank test (log-rank test), multivariate analysis was Cox risk regression model and binary Logistic regression analysis). Results: pathological grade (HR:1.86, P0. 03), lymph node metastasis (HR:4,P0.01), tumor pathological T stage (HR:1.68, P0. 04), preoperative CA19-9 level (HR:2.17,P=0.01) and postoperative 纬 -GT level (HR:2.06, P0. 02) were proved to be independent risk factors for recurrence after radical operation. The optimal cut-off point of preoperative CA19-9 level was 1000U / ml, and the best value of post-operative 纬 -GT level was the early recurrence prediction model of 100U/l.1 year: the score of 2. 3 * pathological differentiation (middle / low differentiation: 1 point). High differentiation: 0) 2.9 * pathological T stage (T3 / T4: 1, T1 / T2: 0) 3.1 * lymph node (local metastasis: 1, no metastasis: 0) -5.7. The probability of early recurrence within 1 year after operation was 1 / [1 EXP (- ER score)]. Conclusion: pathological grade, lymph node metastasis, tumor pathological T stage, preoperative CA19-9 level and postoperative 纬 -GT level can predict the prognosis of patients with hilar cholangiocarcinoma after radical operation. It is helpful to establish new preoperative (laparoscopic exploration and / or neoadjuvant therapy) and postoperative (prophylactic adjuvant chemotherapy) treatment strategies.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.8
本文编号：2241695
[Abstract]:Background: hilar cholangiocarcinoma (Perihilar cholangiocarcinoma, PHC) refers to the mucosal epithelial carcinoma of the common hepatic duct and the left and right hepatic ducts that occur above the opening of the gallbladder duct, and the prognosis is poor. Surgical resection is the only chance and main treatment of the disease. However, 40-60% of the patients still had recurrence or distant metastasis after radical resection, most of which were early recurrence within one year. For resectable hilar cholangiocarcinoma, the key to establish preoperative and postoperative treatment strategies is to identify prognostic risk factors. The objective of this study was to explore the risk factors for predicting recurrence of hilar cholangiocarcinoma after radical resection, and to establish a scoring model for predicting early recurrence according to the high risk factors. Methods: the study included 66 patients who underwent radical resection of hilar cholangiocarcinoma from May 2011 to May 2014. To analyze the correlation between clinicopathological features and recurrence free survival (Recurrence Free Survival Time). Univariate analysis included Kaplan-Meier analysis and logarithmic rank test (log-rank test), multivariate analysis was Cox risk regression model and binary Logistic regression analysis). Results: pathological grade (HR:1.86, P0. 03), lymph node metastasis (HR:4,P0.01), tumor pathological T stage (HR:1.68, P0. 04), preoperative CA19-9 level (HR:2.17,P=0.01) and postoperative 纬 -GT level (HR:2.06, P0. 02) were proved to be independent risk factors for recurrence after radical operation. The optimal cut-off point of preoperative CA19-9 level was 1000U / ml, and the best value of post-operative 纬 -GT level was the early recurrence prediction model of 100U/l.1 year: the score of 2. 3 * pathological differentiation (middle / low differentiation: 1 point). High differentiation: 0) 2.9 * pathological T stage (T3 / T4: 1, T1 / T2: 0) 3.1 * lymph node (local metastasis: 1, no metastasis: 0) -5.7. The probability of early recurrence within 1 year after operation was 1 / [1 EXP (- ER score)]. Conclusion: pathological grade, lymph node metastasis, tumor pathological T stage, preoperative CA19-9 level and postoperative 纬 -GT level can predict the prognosis of patients with hilar cholangiocarcinoma after radical operation. It is helpful to establish new preoperative (laparoscopic exploration and / or neoadjuvant therapy) and postoperative (prophylactic adjuvant chemotherapy) treatment strategies.
【学位授予单位】：浙江大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R735.8
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