淋巴管、血管及神经侵犯对肝内胆管细胞癌术后复发和生存的影响

摘要/Abstract

摘要： 目的分析淋巴管、血管及神经侵犯对肝内胆管细胞癌(ICC)患者术后复发和生存的影响。方法回顾2008年1月至2016年6月ICC患者142例(男74例、女68例),年龄63(56,74)岁。ICC经肝切除术后病理证实。比较不同淋巴管、血管及神经侵犯状态ICC患者临床资料,同时分析无复发生存率、生存率。根据资料类型,采用t检验/卡方检验比较;无复发生存率、生存率比较采用KM法、log-rank检验。结果 ICC患者中淋巴管侵犯40例、淋巴管未侵犯102例。淋巴管侵犯患者血管侵犯、神经侵犯及内脏侵犯为15例(37.5%)、19例(47.5%)及11例(27.5%),与淋巴结未侵犯[3例(3.0%)、4例(3.9%)及8例(7.8%)]比,差异具有统计学意义(P<0.05)。ICC患者中血管侵犯18例、血管未侵犯124例。血管侵犯患者T1/T2、T3/T4分期为10例(55.6%)、8例(44.4%),血管未侵犯患者T1/T2、T3/T4分期为97例(78.2%)、27例(21.8%),差异具有统计学意义(P<0.05);血管侵犯患者中淋巴管侵犯、神经侵犯为10例(55.6%)、12例(66.7%),与血管未侵犯[30例(24.0%)、11例(8.9%)]比,差异具有统计学意义(P<0.05)。ICC患者中神经侵犯23例、神经未侵犯119例。神经侵犯患者淋巴管侵犯、血管侵犯为12例(52.2%)、7例(30.5%),与神经未侵犯[38例(23.5%)、11例(9.3%)]比,差异具有统计学意义(P<0.05)。不同淋巴管、血管及神经侵犯状态ICC患者术后1年、3年及5年无复发生存率差异均无统计学意义(P>0.05);神经侵犯ICC患者术后1年、3年及5年总体生存率为73.9%(17/23)、21.7%(5/23)及0(0/23),与神经未侵犯[79.8%(95/119)、34.4%(41/119)及27例(22.7%)]比,差异具有统计学意义(P<0.05)。结论存在神经侵犯的ICC患者总体生存率较差,而不同淋巴管、血管状态患者的无复发生存率、总体生存率并无显著性差异。

关键词: 肝内胆管细胞癌, 神经侵犯, 总体生存率

Abstract: Objective To analyze the influence of lymphatic, vascular and nerve invasion on postoperative recurrence and survival of patients with intrahepatic cholangiocarcinoma (ICC).Methods One hundred and forty-two ICC patients collected from January 2008 to June 2016 were retrospectively analyzed. There were 74 males and 68 females patients with an average age of 63 (56, 74) years. The diagnosis of ICC was confirmed by pathology after hepatectomy. The clinical data of the ICC patients with different lymphatic, vascular and nerve invasion states were analyzed, alone with their recurrence-free survival rate and survival rate. T-test and Chi-square test were used for statistical comparisons according to the data types. The recurrence-free survival rate and survival rate were compared by KM method and log-rank test.Results In the ICC patients, there were 40 cases with and 102 cases without lymphatic invasion. There were 15 cases (37.5%), 19 cases (47.5%) and 11 cases (27.5%) of vascular, nerve and visceral invasion in patients with lymphatic invasion, respectively, which were significantly different from those without lymphatic invasion [3 cases (3.0%), 4 cases (3.9%) and 8 cases (7.8%), respectively] (P<0.05). In ICC patients, there were 18 cases with vascular and 124 cases without vascular invasion. The T1/T2, T3/T4 staging of patients with vascular invasion was 10 cases (55.6%) and 8 cases (44.4%), while the T1/T2, T3/T4 staging of patients without vascular invasion was 97 cases (78.2%) and 27 cases (21.8%), respectively, with statistical significance (P<0.05). Among the patients with vascular invasion, 10 cases (55.6%) had lymphatic invasion and 12 cases (66.7%) had nerve invasion, which was significantly different from those without vascular invasion [(30 cases (24.0%) and 11 cases (8.9%), respectively) (P<0.05). In ICC patients, there were 23 cases with and 119 cases without nerve invasion. There were 12 cases (52.2%) of lymphatic invasion and 7 cases (30.5%) of vessel invasion in the nerve invasion patients, which were significantly different from those without nerve invasion [38 cases (23.5%) and 11 cases (9.3%), respectively) (P<0.05). There was no significant difference in the recurrence-free survival rates among ICC patients with different lymphatic, vascular and nerve invasion states at 1, 3 and 5 years after operation (P>0.05). The 1-year, 3-year and 5-year overall survival rates of ICC patients with nerve invasion were 73.9% (17/23), 21.7% (5/23) and 0 (0/23), while those without nerve invasion were 79.8% (95/119), 34.4% (41/119) and 27 cases (22.7%), respectively, with statistical significance (P<0.05).Conclusion The overall survival rate of ICC patients with nerve invasion is poor, while the recurrence-free survival rates and overall survival rates of patients with different lymphatic and vascular states have no significant difference.

Key words: Intrahepatic cholangiocarcinoma, Nerves invasion, Overall survival rate

李慧娟, 杨立品, 赵莎莎. 淋巴管、血管及神经侵犯对肝内胆管细胞癌术后复发和生存的影响[J]. 肝脏, 2022, 27(4): 466-469.

LI Hui-juan, YANG Li-pin, ZHAO Sha-sha. The influence of lymphatic, blood vessel, and nerve invasion on the postoperative recurrence and survival of patients with intrahepatic cholangiocarcinoma[J]. Chinese Hepatolgy, 2022, 27(4): 466-469.

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