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AJCC分期、术前PNI及不同淋巴结清扫方式与接受根治术治疗的ICC患者预后结局的关系

The relationship between AJCC stage,preoperative PNI and different lymph node dissection methods and the prognosis of ICC patients undergoing radical surgery
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摘要 目的探讨第8版美国癌症联合委员会(AJCC)分期、术前预后营养指数(PNI)及不同淋巴结清扫方式与接受根治术治疗的肝内胆管细胞癌(ICC)患者预后结局的关系。方法选取本院2019年1月—2021年1月收治的105例ICC患者进行回顾性分析与病例对照研究相结合的方式进行研究,所有患者均接受肿瘤根治术治疗,其中59例患者术中采用整块融合清扫方式清扫淋巴结(A组)、另外46例患者术中采用传统常规的淋巴结清扫方式(B组),对两组患者随访1年观察生存率及生存时间进行比较;统计不同预后结局患者的AJCC分期、PNI及一般临床病理学参数,采用Logistic回归模型分析影响患者预后结局的关键因素。结果A组患者18个月随访后生存率为84.75%,B组为67.39%,A组显著高于B组,差异具有统计学意义(P<0.05);A组患者的生存时间长于B组患者,差异具有统计学意义(Log Rank(Mantel-Cox)=4.994,P=0.025)。死亡组患者T分期中≥T2期、N分期中N1分期、TNM分期中≥Ⅱ期、PNI指标<45.0的患者占比均显著高于生存组,差异具有统计学意义(P<0.05)。Logistic回归模型结果显示,TBIL≥20.0μmol/L、肿瘤数目多发、发生血管侵犯、手术中输血、N1分期、TNM分期≥Ⅱ期、PNI指标<45.0、常规淋巴结清扫方式是ICC患者不良预后结局的独立危险因素(P<0.05)。结论根据ICC患者的AJCC分期、术前PNI水平可以初步评估患者根治术后的预后结局,根治术中采取整块融合清扫方式清扫淋巴结有利于延长患者的生存时间。 Objective To investigate the relationship between the eighth edition of American Joint Committee on Cancer(AJCC)staging,preoperative prognostic nutritional index(PNI)and the prognosis of patients with intrahepatic cholangiocarcinoma(ICC)treated with different lymph node dissection methods.Methods 105 ICC patients admitted to our hospital from January 2019 to January 2021 were selected for study by combining retrospective analysis and case-control study.All patients received radical tumor resection,and 59 patients were treated with en bloc fusion dissection for lymph node dissection(group A).Another 46 patients were treated with traditional routine lymph node dissection(group B),and the two groups of patients were followed up for 1 year to observe the survival rate and survival time.Logistic regression model was used to analyze the key factors affecting the prognosis of patients.Results After 18-month follow-up,the survival rate of patients in group A was 84.75%,and that in group B was 67.39%.Group A was significantly higher than group B,and the difference was statistically significant(P<0.05).The survival time of patients in group A was longer than that in group B,and the difference was statistically significant(Log Rank(Mantel-Cox)=4.994,P=0.025).The proportion of dead patients with T stage≥T2 stage,N1 stage in N stage,TNM stage≥Ⅱstage,and PNI index≥45.0 were significantly higher than those in the survival group,and the difference was statistically significant(P<0.05).Logistic regression model results showed that:TBIL≥20.0μmol/L,multiple tumors,vascular invasion,intraoperative blood transfusion,N1 stage,TNM stage≥Ⅱ,and PNI index<45.0 were independent risk factors for poor prognosis in patients with ICC(P<0.05).Conclusion According to the AJCC staging and preoperative PNI level of ICC patients,the prognosis of patients after radical resection can be preliminarily evaluated.En bloc dissection of lymph nodes during radical resection is beneficial to prolong the survival time of patients.
作者 朱建国 杨秋宝 刘畅 查全勇 张巍 ZHU Jianguo;YANG Qiubao;LIU Chang;ZHA Quanyong;ZHANG Wei(Department of Emergency,Ezhou Central Hospital,Ezhou 436000,Hubei,China)
出处 《西部医学》 2024年第9期1355-1359,共5页 Medical Journal of West China
基金 湖北省卫生计生委科研立项项目(WJ2017Q033)。
关键词 美国癌症联合委员会 预后营养指数 淋巴结清扫 根治手术 肝内胆管细胞癌 预后 American Joint Committee on Cancer Prognostic nutritional index Lymph node dissection Radical surgery Intrahepatic cholangiocarcinoma Prognosis
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