中下段胆管癌的预后影响因素分析*

目的:探讨中下段胆管癌的预后影响因素。方法:对79例中下段胆管癌患者的临床资料进行回顾性分析,采用Kaplan-Meier分析对确定的单因素进行生存率的描述,用Cox回归进行多因素分析,采用log-rank法对单因素进行生存分析评价。结果:79例患者1、3、5年生存率分别为70.2%,36.2%,19.1%,中位生存时间为19.8个月。行根治性手术患者1年、3年、5年生存率分别为87.9%、45.5%和24.2%,分别显著高于姑息性手术患者1年、3年、5年生存率(28.9%、14.3%和7.1%);行根治性手术患者的中位生存时间为34.5个月,较姑息性手术患者显著延长(8个月),根治术与姑息性手术1、3、5年生存率及中位生存时间比较四项均P<0.01,差异具有统计学意义。单因素分析显示肿瘤病理分化,慢性病史,淋巴结转移为影响中下段胆管癌预后的因素。多因素分析显示慢性病史、手术切缘、肿瘤病理分化程度是影响中下段胆管癌预后的独立危险因素。结论:慢性病史、手术切缘、肿瘤病理分化程度为中、下段胆管癌行切除术后预后的独立危险因素,根治性手术可提高中、下段胆管癌患者的生存率和延长其生存时间。

Analysis of the Prognostic Factors of Middle and Distal Bile Duct Carcinoma*

Objective: To investigate the prognostic factors of middle and distal bile duct carcinoma.Methods: A retrospective clinical analysis was made on 79 cases of middle and distal bile duct carcinoma.Clinicopathologic factors with possible prognostic significances were selected and analyzed.Survival was calculated with the Kaplan-Meier method.A multivariate analysis of these individuals was performed using the Cox proportional Hazards Model.Results: The 1-,3-,and 5-year survival rates were 70.2%,36.2%,19.1% respectively,and the median survival time was 19.8 months.Radical resection was performed on 53 cases and palliative operation was performed on 14 cases.The 1-,3-,and 5-year survival rates were 87.9% vs 28.9%(P<0.01),45.5% vs 14.3%(P<0.01) and 24.2% vs 7.1%(P<0.01) respectively,and the median survival time was 19.8 vs 8 months(P<0.01).The statistical analysis showed that chronic disease,histopathological grade and lymph node metastasis affected postoperative survival significantly.In multivariate analysis,chronic disease,histopathological grade and surgical margin status were significant independent prognostic factors.Conclusions: Radical resection is an important strategy to improve the long-survival of postoperative patients in middle and distal bile duct carcinoma.Chronic disease,histopathological grade and surgical margin status were significant independent prognostic factors.