摘要
目的分析肝内胆管细胞癌(ICC)患者淋巴结转移的危险因素,建立ICC淋巴结转移的风险预测模型。方法回顾性分析2007年1月至2011年12月在海军军医大学第三附属医院(上海东方肝胆外科医院)行肝部分切除联合淋巴结清扫的587例ICC患者的临床病理资料,其中男性395例,女性192例,年龄(54.7±10.8)岁,年龄范围20~82岁。通过单因素和多因素logistic回归分析筛选出淋巴结转移的独立危险因素,并构建风险预测模型,采用受试者工作特征(ROC)曲线评价模型的准确性。结果587例ICC患者淋巴结转移的发生率为26.9%(158/587)。多因素logistic回归分析显示,血小板>300×10^(9)/L(OR=1.985,95%CI:1.030~3.824,P=0.041)、肿瘤糖类抗原19-9>37 U/ml(OR=2.978,95%CI:1.994~4.448,P<0.001)、肿瘤位于肝左叶(OR=1.579,95%CI:1.065~2.341,P=0.023)、多发肿瘤(OR=1.846,95%CI:1.225~2.783,P=0.003)、无肝硬化(OR=2.125,95%CI:1.192~3.783,P=0.011)是ICC患者淋巴结转移的独立危险因素。据此建立的风险预测模型的ROC曲线下面积为0.714,其截断值为0.215,灵敏度为75.9%,特异度为58.3%。结论基于术前易于获取的临床指标构建了ICC淋巴结转移的风险预测模型,该模型有较好的评估效能,可为ICC的治疗决策提供一定的参考。
Objective To study the risk factors of lymph node metastases in patients with intrahepatic cholangiocarcinoma(ICC)and to establish a risk prediction model of lymph node metastases in ICC.Methods The clinicopathological data of 587 ICC patients who underwent radical hepatectomy and lymph node dissection at Third Affiliated Hospital of Naval Medical University(Shanghai Eastern Hepatobiliary Surgery Hospital)from January 2007 to December 2011 were retrospectively analyzed.There were 395 males and 192 females with ages which ranged from 20 to 82(54.7±10.8)years.Independent risk factors of lymph node metastases were studied using univariate and multivariate logistic regression analysis,and a risk prediction model was established.Receiver operating characteristic(ROC)curve was used to evaluate the accuracy of this model.Results Of 587 patients,158(26.9%)had lymph node metastases.Multivariate logistic regression analysis showed that platelet count>300×10^(9)/L(OR=1.985,95%CI:1.030-3.824,P=0.041),carbohydrate antigen 19-9>37 U/ml(OR=2.978,95%CI:1.994-4.448,P<0.001),tumor situated in left hemiliver(OR=1.579,95%CI:1.065-2.341,P=0.023),multiple tumors(OR=1.846,95%CI:1.225-2.783,P=0.003),and absence of cirrhosis(OR=2.125,95%CI:1.192-3.783,P=0.011)were independent risk factors for lymph node metastases in ICC.The area under the ROC curve was 0.714,with a cutoff value of 0.215,and the sensitivity and specificity being 75.9%and 58.3%,respectively.Conclusions The risk prediction model of ICC lymph node metastases was established using readily available clinical data obtained before operation.This model has good predictive values and can provide a reference for treatment decision on patients with ICC.
作者
施学兵
李炜
李志臻
谢智华
张吉祥
冯飞灵
姜小清
Shi Xuebing;Li Wei;Li Zhizhen;Xie Zhihua;Zhang Jixiang;Feng Feiling;Jiang Xiaoqing(Department of Biliary Tract SurgeryⅠ,Third Affiliated Hospital of Naval Medical University(Shanghai Eastern Hepatobiliary Surgery Hospital),Shanghai 200438,China)
出处
《中华肝胆外科杂志》
CAS
CSCD
北大核心
2022年第5期333-336,共4页
Chinese Journal of Hepatobiliary Surgery
基金
国家自然科学基金(81972256)
上海市医学重点专科建设项目—普外科(ZK2019B18)
上海市普陀区临床特色专病建设项目(2020tszb03)。
关键词
胆管肿瘤
危险因素
肝内胆管细胞癌
淋巴结转移
预测模型
Bile duct neoplasms
Risk factors
Intrahepatic cholangiocarcinoma
Lymph node metastasis
Predictive model
