Prognostic factors of intrahepatic cholangiocarcinoma patients undergoing curative resection

doi:10.3877/cma.j.issn.1674-0793.2019.02.004

Abstract

Abstract:

Objective

To identify the independent prognostic factors of intrahepatic cholangiocarcinoma (ICC) patients after receiving curative (R0) resection.

Methods

From January 2002 to August 2018, the clinicopathological and prognosis data of two hundred and thirty-seven patients with the pathological diagnosis of ICC in the First Affiliated Hospital of Sun Yat-sen University who underwent curative resection were analyzed retrospectively. The survival curve was constructed by Kaplan-Meier method. Univariate and multivariate COX regression analysis were used to screen independent factors affecting survival and prognosis of patients. C-index, ROC curve, AUC curve and calibration curve were used to evaluate the predictive effectiveness of COX regression model.

Results

The median survival time of ICC patients was 19.93 months (95%CI=14.31-26.21), and the 1-, 2-, and 3-year survival rates were 62.3%, 45.0%, and 35.6%, respectively. Univariate and multivariate regression analysis demonstrated that gamma-glutamyl transpeptidase (GGT) >53 U/L (P=0.001), CA125>17.4 U/ml (P<0.001), lymph node metastasis (P=0.039) and poor tumor differentiation (P<0.001) were the adverse factors of prognosis after R0 resection in ICC patients. According to the criteria for deleting probability: P>0.1, the C-index of the prognostic model containing CEA (P=0.092) was 0.74 (95%CI=0.68-0.78). The AUC values corresponding to different follow-up time points were all around 0.8, and the model had good prediction efficiency.

Conclusion

GGT, CEA, CA125, lymph node metastasis and poor tumor differentiation are prognostic predictors of ICC patients after receiving R0 resection.

Key words: Carcinoma, cholangiocellular, Hepatectomy, Prognosis, Factor analysis, statistical

Xuan Luo, Li Huang, Bin Li, Shuling Chen, Ming Kuang, Jiaming Lai. Prognostic factors of intrahepatic cholangiocarcinoma patients undergoing curative resection[J]. Chinese Archives of General Surgery(Electronic Edition), 2019, 13(02): 103-108.

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References 27

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项目		例数(%)	项目		例数(%)	项目		例数(%)
年龄(岁)		?	INR		1.0(0.1~2.0)^a	肿瘤大小(cm)		6.0(0.1~16)^a
?	≤60	128(54.0)	?	≤1.07	171(72.2)	?	≤5	81(35.8)
?	>60	109(46.0)	?	>1.07	66(27.8)	?	>5	145(64.2)
性别		?	CA19-9(U/ml)		111.0(0~12 000)^a	肿瘤个数		?
?	男	138(58.2)	?	≤51.4	83(35.0)	?	1	172(75.8)
?	女	99(41.8)	?	>51.4	154(65.0)	?	2~3	19(8.4)
Hb(g/L)		130.0(3.8~178.0)^a	CEA(μg/L)		3.0(0.6~3 203.5)^a	?	>3	36(15.8)
?	≤122	77(32.5)	?	≤3	119(50.2)	血管侵犯		?
?	>122	160(67.5)	?	>3	118(49.8)	?	无	152(64.1)
ALB(g/L)		39.9(20.3~59.0)^a	CA125(U/ml)		20.7(2.6~6 197.6)^a	?	有	85(35.9)
?	≤40	127(53.6)	?	≤17.4	87(36.7)	胆管侵犯		?
?	>40	110(46.4)	?	>17.4	150(63.3)	?	无	197(83.8)
TBIL(μmol/L)		12.0(2.4~412.7)^a	HBsAg		?	?	有	38(16.2)
?	≤18.6	187(78.9)	?	阴性	165(69.6)	局部侵犯		?
?	>18.6	50(21.1)	?	阳性	72(30.4)	?	无	178(75.1)
ALT(U/L)		25.0(5.0~560.0)^a	丙型肝炎		?	?	有	59(24.9)
?	≤49	181(76.4)	?	阴性	227(96.6)	淋巴结转移		?
?	>49	56(23.6)	?	阳性	8(3.4)	?	无	158(66.7)
GGT(U/L)		91.0(12.0~1 776.0)^a	肝硬化		?	?	有	79(33.3)
?	≤53	61(25.7)	?	无	201(84.8)	分化程度		?
?	>53	176(74.3)	?	有	36(15.2)	?	Ⅰ~Ⅱ	115(59.6)
PT(s)		11.9(10.2~131.0)^a	胆管结石		?	?	Ⅲ	78(40.4)
?	≤12.5	180(75.9)	?	无	154(66.7)	术中输血		?
?	>12.5	57(24.1)	?	有	77(33.3)	?	无	157(66.2)
?	?	?	?	?	?	?	有	80(33.8)

项目		例数(%)	项目		例数(%)	项目		例数(%)
年龄(岁)		?	INR		1.0(0.1~2.0)^a	肿瘤大小(cm)		6.0(0.1~16)^a
?	≤60	128(54.0)	?	≤1.07	171(72.2)	?	≤5	81(35.8)
?	>60	109(46.0)	?	>1.07	66(27.8)	?	>5	145(64.2)
性别		?	CA19-9(U/ml)		111.0(0~12 000)^a	肿瘤个数		?
?	男	138(58.2)	?	≤51.4	83(35.0)	?	1	172(75.8)
?	女	99(41.8)	?	>51.4	154(65.0)	?	2~3	19(8.4)
Hb(g/L)		130.0(3.8~178.0)^a	CEA(μg/L)		3.0(0.6~3 203.5)^a	?	>3	36(15.8)
?	≤122	77(32.5)	?	≤3	119(50.2)	血管侵犯		?
?	>122	160(67.5)	?	>3	118(49.8)	?	无	152(64.1)
ALB(g/L)		39.9(20.3~59.0)^a	CA125(U/ml)		20.7(2.6~6 197.6)^a	?	有	85(35.9)
?	≤40	127(53.6)	?	≤17.4	87(36.7)	胆管侵犯		?
?	>40	110(46.4)	?	>17.4	150(63.3)	?	无	197(83.8)
TBIL(μmol/L)		12.0(2.4~412.7)^a	HBsAg		?	?	有	38(16.2)
?	≤18.6	187(78.9)	?	阴性	165(69.6)	局部侵犯		?
?	>18.6	50(21.1)	?	阳性	72(30.4)	?	无	178(75.1)
ALT(U/L)		25.0(5.0~560.0)^a	丙型肝炎		?	?	有	59(24.9)
?	≤49	181(76.4)	?	阴性	227(96.6)	淋巴结转移		?
?	>49	56(23.6)	?	阳性	8(3.4)	?	无	158(66.7)
GGT(U/L)		91.0(12.0~1 776.0)^a	肝硬化		?	?	有	79(33.3)
?	≤53	61(25.7)	?	无	201(84.8)	分化程度		?
?	>53	176(74.3)	?	有	36(15.2)	?	Ⅰ~Ⅱ	115(59.6)
PT(s)		11.9(10.2~131.0)^a	胆管结石		?	?	Ⅲ	78(40.4)
?	≤12.5	180(75.9)	?	无	154(66.7)	术中输血		?
?	>12.5	57(24.1)	?	有	77(33.3)	?	无	157(66.2)
?	?	?	?	?	?	?	有	80(33.8)

项目	HR	95%CI	P值	项目	HR	95%CI	P值
年龄(>60岁)	0.92	0.65~1.31	0.639	丙型肝炎(阳性)	0.73	0.27~1.99	0.542
性别(女)	0.88	0.62~1.26	0.491	合并肝硬化(有)	0.91	0.54~1.52	0.711
Hb(>122 g/L)	0.59	0.41~0.85	0.005^a	胆管结石(有)	1.30	0.90~1.88	0.155
ALB(>40 g/L)	0.65	0.45~0.92	0.017^a	肿瘤大小(>5 cm)	1.68	1.13~2.51	0.011^a
TBIL(>18.6 μmol/L)	1.42	0.94~2.13	0.096	肿瘤数目(个)	?	?	?
ALT(>49 U/L)	1.40	0.96~2.06	0.083	2~3	1.19	0.65~2.19	0.564
GGT(>53 U/L)	2.51	1.56~4.06	<0.001^a	>3	1.82	1.16~2.84	0.009^a
PT(>12.5 s)	1.61	1.10~2.37	0.015^a	血管侵犯(有)	1.89	1.31~2.72	0.001^a
INR(>1.07)	1.45	1.00~2.12	0.051	胆管侵犯(有)	1.01	0.61~1.67	0.967
CA19-9(>51.4 U/ml)	1.89	1.27~2.80	0.002^a	局部侵犯(有)	1.25	0.84~1.86	0.264
CEA(>3 μg/L)	1.68	1.18~2.40	0.004^a	淋巴结转移(有)	1.99	1.39~2.85	<0.001^a
CA125(>17.4 U/ml)	2.65	1.77~3.96	<0.001^a	分化程度(Ⅲ级)	1.67	1.12~2.48	0.012^a
HBsAg(阳性)	1.10	0.76~1.59	0.612	术中输血(有)	1.99	1.40~2.83	<0.001^a

项目	HR	95%CI	P值	项目	HR	95%CI	P值
年龄(>60岁)	0.92	0.65~1.31	0.639	丙型肝炎(阳性)	0.73	0.27~1.99	0.542
性别(女)	0.88	0.62~1.26	0.491	合并肝硬化(有)	0.91	0.54~1.52	0.711
Hb(>122 g/L)	0.59	0.41~0.85	0.005^a	胆管结石(有)	1.30	0.90~1.88	0.155
ALB(>40 g/L)	0.65	0.45~0.92	0.017^a	肿瘤大小(>5 cm)	1.68	1.13~2.51	0.011^a
TBIL(>18.6 μmol/L)	1.42	0.94~2.13	0.096	肿瘤数目(个)	?	?	?
ALT(>49 U/L)	1.40	0.96~2.06	0.083	2~3	1.19	0.65~2.19	0.564
GGT(>53 U/L)	2.51	1.56~4.06	<0.001^a	>3	1.82	1.16~2.84	0.009^a
PT(>12.5 s)	1.61	1.10~2.37	0.015^a	血管侵犯(有)	1.89	1.31~2.72	0.001^a
INR(>1.07)	1.45	1.00~2.12	0.051	胆管侵犯(有)	1.01	0.61~1.67	0.967
CA19-9(>51.4 U/ml)	1.89	1.27~2.80	0.002^a	局部侵犯(有)	1.25	0.84~1.86	0.264
CEA(>3 μg/L)	1.68	1.18~2.40	0.004^a	淋巴结转移(有)	1.99	1.39~2.85	<0.001^a
CA125(>17.4 U/ml)	2.65	1.77~3.96	<0.001^a	分化程度(Ⅲ级)	1.67	1.12~2.48	0.012^a
HBsAg(阳性)	1.10	0.76~1.59	0.612	术中输血(有)	1.99	1.40~2.83	<0.001^a

变量	Coef.	Std.Err	HR	95%CI	P值
GGT(>53 U/L)	0.98	2.89	2.68	1.52~4.71	0.001
CEA(>3 μg/L)	0.36	0.22	1.44	0.94~2.20	0.092
CA125(>17.4 U/ml)	0.96	0.24	2.61	1.63~4.17	<0.001
淋巴结转移	0.44	0.21	1.55	1.02~2.36	0.039
分化程度(Ⅲ级)	0.84	0.21	2.31	1.52~3.50	<0.001

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