中华肝胆外科杂志
中華肝膽外科雜誌
중화간담외과잡지
CHINESE JOURNAL OF HEPATOBILIARY SURGERY
2014年
9期
662-666
,共5页
朱倩%乔国梁%晏建军%严以群
硃倩%喬國樑%晏建軍%嚴以群
주천%교국량%안건군%엄이군
肝门部胆管癌%糖链抗原19-9,截点%淋巴结转移%切缘%影响因素,预后
肝門部膽管癌%糖鏈抗原19-9,截點%淋巴結轉移%切緣%影響因素,預後
간문부담관암%당련항원19-9,절점%림파결전이%절연%영향인소,예후
Hilar cholangiocarcinoma%Carbhydrate antigen 19-9,cutoff point%Lymph node metastasis%Resection margin%Risk factors,prognosis
目的 研究对肝门部胆管癌预后影响最大的CA19-9的截点值,探索手术切除肝门部胆管癌患者的预后因素.方法 回顾性分析2003年4月至2009年1月于东方肝胆外科医院手术治疗的168例肝门部胆管癌患者资料.单因素分析其CA19-9水平对判断预后最有价值的截点,后行多因素分析,得出独立预后因素.结果 术前CA19-9水平对预后判断最有价值的截点值为150 kU/L(P＜0.001).单因素分析显示年龄、肿瘤大小、分化程度、Bismuth-Corlette分型、门静脉侵犯、肝动脉侵犯、术前减黄、淋巴结转移及切缘均会影响肝门部胆管癌的预后.多因素分析证实只有淋巴结转移、切缘及CA19-9是影响肝门部胆管癌预后的独立危险因素.结论 CA19-9水平是影响肝门部胆管癌预后的独立因素,其对预后判断最有价值的截点是150 kU/L.结合术前CA19-9水平不仅有助于肝门部胆管癌患者的术前分期评估,而且有助于决定是否行腹腔探查并推断肝门部胆管癌的预后.
目的 研究對肝門部膽管癌預後影響最大的CA19-9的截點值,探索手術切除肝門部膽管癌患者的預後因素.方法 迴顧性分析2003年4月至2009年1月于東方肝膽外科醫院手術治療的168例肝門部膽管癌患者資料.單因素分析其CA19-9水平對判斷預後最有價值的截點,後行多因素分析,得齣獨立預後因素.結果 術前CA19-9水平對預後判斷最有價值的截點值為150 kU/L(P＜0.001).單因素分析顯示年齡、腫瘤大小、分化程度、Bismuth-Corlette分型、門靜脈侵犯、肝動脈侵犯、術前減黃、淋巴結轉移及切緣均會影響肝門部膽管癌的預後.多因素分析證實隻有淋巴結轉移、切緣及CA19-9是影響肝門部膽管癌預後的獨立危險因素.結論 CA19-9水平是影響肝門部膽管癌預後的獨立因素,其對預後判斷最有價值的截點是150 kU/L.結閤術前CA19-9水平不僅有助于肝門部膽管癌患者的術前分期評估,而且有助于決定是否行腹腔探查併推斷肝門部膽管癌的預後.
목적 연구대간문부담관암예후영향최대적CA19-9적절점치,탐색수술절제간문부담관암환자적예후인소.방법 회고성분석2003년4월지2009년1월우동방간담외과의원수술치료적168례간문부담관암환자자료.단인소분석기CA19-9수평대판단예후최유개치적절점,후행다인소분석,득출독립예후인소.결과 술전CA19-9수평대예후판단최유개치적절점치위150 kU/L(P＜0.001).단인소분석현시년령、종류대소、분화정도、Bismuth-Corlette분형、문정맥침범、간동맥침범、술전감황、림파결전이급절연균회영향간문부담관암적예후.다인소분석증실지유림파결전이、절연급CA19-9시영향간문부담관암예후적독립위험인소.결론 CA19-9수평시영향간문부담관암예후적독립인소,기대예후판단최유개치적절점시150 kU/L.결합술전CA19-9수평불부유조우간문부담관암환자적술전분기평고,이차유조우결정시부행복강탐사병추단간문부담관암적예후.
Objective To investigate the appropriate cutoff point of CA19-9 in prognosis and to determine other potential prognostic factors which may affect survival of patients with hilar cholangiocarcinoma (HC) after radical surgery.Methods 168 patients who had undergone radical surgery for hilar cholangiocarcinoma with R0 and R1 resection were selected for the study.Categorized versions were used in univariate model to determine the appropriate cutoff point of CA19-9.CA19-9 and other clinicopathologic factors were analyzed for their influence on survival using multivariate methods.Results The strongest univariate predictor among the categorized preoperative CA19-9 measures was CA19-9 of less than 150 IU/L (P ＜0.001).On univariate analysis,age,differentiation,tumor size,Bismuth-Corlette classification,portal vein invasion,lymph node metastasis,hepatic artery invasion,liver invasion,preoperative biliary drainage,resection margin and preoperative CA19-9 levels were identified as significant prognostic factors.On multivariable analysis,lymph node metastasis,resection margin and preoperative CA19-9 levels were independent prognostic factors of survival.Conclusions A raised preoperative CA19-9 level was an independent prognostic factor of survival for hilar cholangiocarcinoma.The most discriminative cutoff point of CA19-9 for prognosis was at 150 kU/L.
