肝門部膽管癌根治術(shù)后復(fù)發(fā)高危因素研究
發(fā)布時(shí)間：2018-09-13 16:18
【摘要】：背景： 肝門部膽管癌(Perihilar cholangiocarcinoma, PHC)是指發(fā)生于膽囊管開口以上的肝總管和左右肝管的膽道黏膜上皮癌,預(yù)后較差。手術(shù)切除是本病治愈的唯一機(jī)會(huì)和主要的治療手段。但是根治性手術(shù)切除后仍有40-60%的患者發(fā)生復(fù)發(fā)或遠(yuǎn)處轉(zhuǎn)移,并且大部分為一年內(nèi)的早期復(fù)發(fā)。對(duì)于可切除的肝門部膽管癌,建立術(shù)前和術(shù)后治療策略的重點(diǎn)是明確預(yù)后高危因素。本研究的目標(biāo)便是探索可預(yù)測(cè)肝門部膽管癌根治術(shù)后復(fù)發(fā)的高危因素,并根據(jù)高危因素,初步建立一個(gè)可預(yù)測(cè)早期復(fù)發(fā)的評(píng)分模型。 方法： 該研究包括了從2011年5月至2014年5月共66例行肝門部膽管癌根治術(shù)后的病人。分析其臨床病理特征與無復(fù)發(fā)生存期(Recurrence Free Survival Time)的相關(guān)性。分析方法中單因素分析為Kaplan-Meier分析和對(duì)數(shù)秩檢驗(yàn)(log-rank test),多因素分析為Cox風(fēng)險(xiǎn)回歸模型和二元Logistic回歸分析(是否早期復(fù)發(fā))。 結(jié)果： 病理分級(jí)(HR:1.86, P=0.03)、淋巴結(jié)轉(zhuǎn)移(HR：4,P0.01)、腫瘤病理T分期(HR:1.68, P=0.04)、術(shù)前CA19-9水平(HR：2.17,P=0.01)、術(shù)后γ-GT水平(HR:2.06, P=0.02)被證明為根治術(shù)后復(fù)發(fā)的獨(dú)立高危因素。術(shù)前CA19-9水平的最佳切點(diǎn)值為1000U/ml,術(shù)后γ-GT水平的最佳切點(diǎn)值為100U/l。1年內(nèi)早期復(fù)發(fā)的預(yù)測(cè)模型：ER評(píng)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*淋巴結(jié)(局部轉(zhuǎn)移：1分,無轉(zhuǎn)移：0分)-5.7。術(shù)后1年內(nèi)早期復(fù)發(fā)的概率為1/[1+EXP(-ER評(píng)分)]。 結(jié)論： 病理分級(jí)、淋巴結(jié)轉(zhuǎn)移、腫瘤病理T分期、術(shù)前CA19-9水平、術(shù)后γ-GT水平可預(yù)測(cè)肝門部膽管癌根治術(shù)后患者的預(yù)后,有助于建立新的術(shù)前(腹腔鏡探查和/或新輔助治療)和術(shù)后(預(yù)防性輔助化療)治療策略。
[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 緯 -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 緯 -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 緯 -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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.8
本文編號(hào)：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 緯 -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 緯 -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 緯 -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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.8
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