【摘要】 目的探讨AFP阳性肝内胆管细胞癌(ICC)患者的临床特点及预后影响因素。方法回顾性研究2004年9月至2013年12月在中山大学附属第三医院接受诊治的57例ICC患者临床资料。所有患者均签署知情同意书,符合医学伦理学规定。其中男34例,女23例;平均年龄(52±13)岁。根据入院后血清AFP检测结果将患者分为AFP阳性组(16例)和AFP阴性组(41例)。比较两组患者的年龄、性别、HBs Ag,合并肝硬化、胆道病变,术前糖链抗原19-9(CA19-9)、手术方式、淋巴结转移、组织学分化程度等临床病理学参数。对患者进行随访,记录两组生存情况。临床病理学参数比较采用t检验、χ2检验或Fisher确切概率法,生存预后影响因素分析采用Log-rank检验和Cox比例风险回归模型多因素分析。结果 AFP阳性组中男性占94%(15/16),明显高于AFP阴性组的46%(19/41)(χ2=10.747,P<0.05)。AFP阳性组合并肝硬化患者占88%(14/16),明显高于AFP阴性组的37%(15/41)(χ2=11.937,P<0.05)。AFP阳性组患者无合并胆道病变,AFP阴性组12例合并胆道病变,两组比较差异有统计学意义(P<0.05)。手术方式为AFP阳性组患者预后的独立危险因素,根治性切除患者预后好(RR=26.813,P<0.05)。结论 AFP阳性ICC患者多合并肝硬化,较少合并胆道病变。手术方式为影响患者预后的独立危险因素,根治性切除是改善AFP阳性ICC患者预后的有效手段。更多还原

【Abstract】 Objective To investigate the clinical characteristics and prognostic factors in intrahepatic cholangiocarcinoma(ICC) patients with positive alpha-fetoprotein(AFP). Methods Clinical data of 57 patients with ICC in the Third Affiliated Hospital of Sun Yat-sen University from September 2004 to December 2013 were analyzed retrospectively. The informed consents of all patients were obtained and the ethical committee approval was received. There were 34 males and 23 females with an average age of(52±13) years old. According to serum AFP test result after admission in hospital, the patients were divided into AFP positive group(n=16) and AFP negative group(n=41). The difference of clinicopathological factors between two groups such as age, gender, hepatitis B surface antigen(HBs Ag), liver cirrhosis, biliary lesions, preoperative carbohydrate antigen 19-9(CA19-9), surgical procedure, metastastic lymph nodes, histological differentiation degree were compared by t-test, Chi-square test or Fisher’s exact probability test. The patients were followed up and the survival of two groups was recorded. Prognostic factors analysis was conducted by Log-rank test and Cox proportional hazards regression model. Results Male patients accounted for 94%(15/16) in AFP positive group, which was significantly higher than that in AFP negative group [46%(19/41)](χ2=10.747, P<0.05). Patients complicated with liver cirrhosis accounted for 88%(14/16), which was significantly higher than that in AFP negative group [37%(15/41)](χ2=11.937, P<0.05). No patients were complicated with biliary lesions in AFP positive group but in AFP negative group, 12 cases were complicated with biliary lesions, where significant difference was observed between two groups(P<0.05). Surgical procedure was the independent risk factor for patients in AFP positive group. Patients undergoing radical resection had better prognosis(RR=26.813, P<0.05). Conclusions ICC patients with positive AFP are mostly complicated with liver cirrhosis but a low incidence of biliary lesions. Surgical procedure is the independent risk factor for the prognosis. Radical resection is an effective way to improve the prognosis of ICC patients with positive AFP.更多还原