两种不同分型肝内胆管癌临床病理特征及预后分析

Clinicopathological Features and Prognosis Analysis of Two Different Types of Intrahepatic Cholangiocarcinoma

摘要: 目的：探讨两种不同分型肝内胆管癌的临床病理特征及预后分析。方法：回顾性分析安徽医科大学第二附属医院行根治性手术切除的89例肝内胆管细胞癌患者，按肿瘤解剖部位分为两组：小胆管型肝内胆管癌组52例、大胆管型肝内胆管癌组37例。收集两组患者的一般临床资料、实验室检查结果、肿瘤病理特征及生存状态、生存时间。对两组患者的临床病理特征和术后总生存率对比分析。结果：大胆管型ICC组患者的CA19-9、AST、ALT、ALP、GGT、ALB、TBIL、淋巴结转移率及微血管浸润率明显高于小胆管型ICC组，肿瘤直径明显小于小胆管型ICC组，差异有统计学意义(P < 0.05)，两组ICC患者在年龄、性别、BMI、胆道结石病史、胆道手术史、高血压、糖尿病、乙肝病史、TP、分化程度、脉管癌栓、神经侵犯、MVI无显著统计学差异(P > 0.05)。大胆管型ICC患者1、2和3年总生存率分别为(75.7%、35.1%、8.1%)明显低于小胆管型ICC患者(82.7%、59.6%、30.8%)，P < 0.05差异有统计学意义。大胆管型ICC患者中位生存时间为(11.4个月95%CI 10.8~16.4)、小胆管型ICC患者中位生存时间为(14.3个月95%CI 13.5~18.9)，存在统计学差异(Log Rank P = 0.002)。结论：大胆管型ICC患者术前肝功能更差，更易合并胆道梗阻，更容易发生淋巴转移，微血管浸润，术后生存效果较差。小胆管型ICC患者发病更为隐匿。

Abstract: Objective: To investigate the clinicopathological features and prognosis of two different types of in-trahepatic cholangiocarcinoma. Methods: The clinical data of 89 patients with intrahepatic cholan-giocarcinoma who underwent surgical resection in the Second Affiliated Hospital of Anhui Medical University were retrospectively analyzed, and the patients were divided into two groups according to the anatomical site of tumors: 52 cases of Small Duct Type ICC group and 37 cases of Lager Duct Type ICC group, and the general clinical data, laboratory test results, tumor pathological character-istics, survival status and time of the two groups were collected. Results: The rates of CA19-9, AST, ALT, ALP, GGT, ALB, TBIL, lymph node metastasis and microvascular infiltration rates in the Lager Duct Type ICC group were significantly higher than those in the Small Duct Type ICC group, and the tumor diameter was significantly smaller than that in the Small Duct Type ICC group, with a statis-tically significant difference (P < 0.05), and there were no significant statistical differences (P > 0.05) in age, sex, BMI, history of biliary stones, history of biliary surgery, hypertension, diabetes, history of hepatitis B, TP, degree of differentiation, vascular cancer thrombus, nerve invasion, and MVI (P 0.05). The overall survival rates of 1, 2 and 3 years in Bold IC patients (75.7%, 35.1% and 8.1%) were significantly lower than those in small bile tube ICC patients (82.7%, 59.6% and 30.8%), and the difference in P < 0.05 was statistically significant. There were statistically signifi-cant differences in median survival (11.4 months, 95%CI 10.8~16.4), and in small bile casts ICC (14.3 months, 95%CI 13.5~18.9), (Log Rank P = 0.002). Conclusion: Patients with Lager Duct Type ICC have worse preoperative liver function, are more likely to have biliary obstruction, are more prone to lymphatic metastasis, microvascular infiltration, and have poor postoperative survival. Pa-tients with Small Duct Type ICC have a more insidious onset.