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目的分析肝外胆管癌治疗方法及预后影响因素。方法回顾性分析58例肝外胆管癌患者的临床病理资料,应用Kaplan-Meier法计算生存率,对可能影响患者预后的因素分别进行单因素分析(log-rank检验),应用Cox比例风险模型进行多因素统计分析。结果 58例患者中位生存期为33个月,1、3和5年疾病特异性生存率分别为78.6%、39.3%和17.8%。根治性手术组与非根治性手术组患者1、3、5年疾病特异性生存率分别为88.2%、70.1%、37.4%和71.7%、23.0%、7.8%(P=0.001);行辅助化疗和未行辅助化疗两组3和5年疾病特异性生存率分别为69.1%、39.8%和40.1%、9.3%(P=0.029)。单因素分析的结果显示患者治疗前血清总胆红素、白蛋白水平、组织分化程度、是否行根治术、切缘有无残存肿瘤、有无脉管侵犯、有无淋巴结转移、肝转移以及是否行辅助化疗等因素对生存的影响有统计学意义(P<0.05)。多因素分析结果示根治术、切缘阳性、淋巴转移是影响肝外胆管癌患者生存的重要因素(P<0.05)。结论根治术、淋巴结转移、切缘阳性等因素对肝外胆管癌患者的生存产生重要影响;在肝外胆管癌诊治中,根治术仍是改善预后的重要措施,辅助化疗可能改善生存,但不是独立预后因素。
Objective To analyze the treatment of extrahepatic cholangiocarcinoma and prognostic factors. Methods The clinical and pathological data of 58 patients with extrahepatic cholangiocarcinoma were retrospectively analyzed. The Kaplan-Meier method was used to calculate the survival rate. Univariate analysis (log-rank test) was performed on the factors that may influence the prognosis of patients. Cox proportional hazards model Multivariate statistical analysis. Results The median survival time of the 58 patients was 33 months. The disease-specific survival rates at 1, 3 and 5 years were 78.6%, 39.3% and 17.8%, respectively. The disease-specific survival rates at 1, 3 and 5 years in patients with and without radical surgery were 88.2%, 70.1%, 37.4% and 71.7%, 23.0% and 7.8%, respectively (P = 0.001) The 3 and 5 year disease-specific survival rates were 69.1%, 39.8% and 40.1%, 9.3%, respectively (P = 0.029). The results of univariate analysis showed that patients before treatment serum total bilirubin, albumin levels, the degree of tissue differentiation, radical surgery, cutting edge with or without residual tumor, with or without vascular invasion, with or without lymph node metastasis, liver metastases and whether The effects of adjuvant chemotherapy and other factors on survival were statistically significant (P <0.05). Multivariate analysis showed that radical mastectomy, positive margins and lymphatic metastasis were the important factors affecting the survival of patients with extrahepatic cholangiocarcinoma (P <0.05). Conclusion Radical, lymph node metastasis and positive margins have important influence on the survival of patients with extrahepatic cholangiocarcinoma. In the diagnosis and treatment of extrahepatic cholangiocarcinoma, radical surgery is still an important measure to improve prognosis. Adjuvant chemotherapy may improve survival, but not Independent prognostic factors.