摘要
目的 探讨肝内胆管癌(ICC)的分型、分期与治疗结果.方法 回顾性分析2000年1月至2008年12月上海交通大学医学院附属仁济医院收治的60例ICC患者的临床资料.依据日本肝癌研究会(LCSGJ)对患者进行分型、分期.比较肿瘤分型、分期、手术方式与治疗效果的关系,并分析LCSGJ与国际抗癌协会(UICC)分期的关系.采用Log-rank法和X2检验对结果进行分析.结果 60例ICC患者中52例获得有效随访.其1、3、5年的生存率分别为44%(23/52)、19%(10/52)和10%(5/52).30例行根治性切除,10例行肝移植,11例行姑息性手术,9例行剖腹探查+活组织检杳,不同手术方式的中位生存时间分别为13、3、3和1个月.肿块型、胆管周围浸润型、胆管内型和混合型根治性手术切除率分别为23/31、9/15、5/6和3/8.肿瘤分型、分化程度与预后密切相关(χ2=8.308,10.009,P<0.05),且肿瘤分型与淋巴结转移密切相关(χ2=13.261,5.702,P<0.05).不同病理类型的中位生存时间虽差异无统计学意义,但黏液腺癌患者的预后相对较好,中位生存时间为20个月.LCSGJ分期中Ⅳ期患者的中位生存时间为3.0个月,长于UICC分期中Ⅳ期患者的1.2个月(χ2=3.877,P<0.05).LCSGJ的分型和分期密切相关(χ2=8.288,P<0.05).结论 ICC预后不良.LCSCJ的分型、分期方法简明实用,有助于指导治疗和判断预后.对黏液性ICC应采取积极的手术治疗,而肝移植原则上不用于治疗ICC.
Abstract
Objective To investigate the typing, staging and therapeutic outcome of intrahepatic cholan-giocarcinoma (ICC). Methods The clinical data of 60 ICC patients who were admitted to the Renji Hospital of Shanghai Jiaotong University from January 2000 to December 2008 were retrospectively analyzed. ICC was classi-fied according to the type and TNM staging proposed by the Liver Cancer Study Group of Japan (LCSGJ). The relationships between typing, staging, surgical procedures and therapeutic outcome were investigated, as well as the relationship between the LCSGJ staging system and UICC staging system. Results The 1-, 3-, and 5-year survivals of the 60 ICC patients were 44% (23/52), 19% (10/52) and 10% (5/52), respectively. The median survival time for patients with radical resection (n =30) , liver transplantation (n = 10), palliative surgery (n = 11) and exploratory laparotomy (n=9) were 13, 3, 3 and 1 months, respectively. The radical resection rates for mass-forming type, periductal-infiltrating type, intraductal growth type and mixed type were 23/31, 9/15, 5/6 and 3/8, respectively. There were significant relationships between tumor type, degree of differentiation and prog-nosis (χ2 = 8. 308, 10. 009, P < 0. 05), and between tumor type and lymph node metastasis (χ2 = 13. 261, 5.702, P <0.05). There was no significant difference in survival time between patients with different pathological types, but the prognosis of patients with mucinous adenocarcinoma was better than that in the other types, with a median survival time of 20months. The median survival time of patients in LCSGJ stage Ⅳ was 3. 0 months, which was significantly longer than that in UICC stage Ⅳ (χ2 =3. 877, P <0. 05). Tumor staging was intimately related to the macroscopic type χ2 =8.288, P <0. 05). Conclusions The prognosis of ICC is poor. The typing and staging of LCSGJ is concise and practical, which is helpful in guiding treatment and evaluating progno-sis. Surgical treatment should be applied to mucinous ICC, and liver transplantation is not recommended for the treatment of ICC.
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维普
万方数据