【摘要】 目的探讨肝内胆管癌(ICC)患者预后生存的影响因素,并构建列线图个体化预测患者总生存期(OS)。方法回顾性分析中山大学第一附属医院2008 年1月至2017年12月收治的263例行ICC根治性切除术患者资料。单因素和多因素Cox比例风险回归分析筛选患者OS的独立影响因素,并以此构建列线图,个体化预测ICC根治术后患者生存情况。绘制前白蛋白密度图,研究ICC患者中前白蛋白与临床特征之间的潜在相关性。结果 263例患者中位随访30(1～118)个月,OS 为11(0.5～118)个月,1、2、3年累积生存率分别为55.0%、40.2%及27.5%。单因素及多因素回归分析显示,前白蛋白(P=0.002)、CA19-9(P<0.001)、肿瘤个数(P=0.006)、血管侵犯(P=0.042)、肿瘤细胞分化程度(P=0.004)是影响ICC患者OS的独立危险因素,建立的列线图模型可以较好、较准确地预测ICC患者的总体生存情况,一致性指数为0.730。前白蛋白与肿瘤的T、N、M分期存在一定相关性。结论包含前白蛋白指标的列线图可以较准确地预测ICC患者肝部分切除术后生存。更多还原

【Abstract】 Objective To investigate the factors influencing the prognosis and survival of patients with intrahepatic cholangiocarcinoma (ICC),and to construct a nomogram to predict the patient’s overall survival (OS) individually.Methods A retrospective analysis was performed in two hundred and sixty-three ICC patients who underwent radical hepatectomy from January 2008 to December 2017 in the First Affiliated Hospital of Sun Yat-sen University.Univariate and multivariate Cox proportional hazard regression methods were used to screen the independent influencing factors of the OS of patients,and then to construct the nomogram to individually predict the survival of patients after ICC radical surgery.The potential correlation between pre-albumin and clinical characteristics of ICC patients were also investigated with density mapping.Results The median follow-up period of the 263 patients was 30 (1-118) months,and the OS was 11 (0.5-118) months.The 1,2,and 3-year cumulative survival rates were 55.0%,40.2%,and 27.5%,respectively.Univariate and multivariate Cox proportional hazard regression methods demonstrated that prealbumin (P=0.002),CA19-9 (P<0.001),the number of tumors (P=0.006),vascular invasion (P=0.042) and differentiation of tumors (P=0.004) were the independent risk factors for OS,and the nomogram constructed by the above factors can predict the OS of ICC patients well and accurately,with the C-index of 0.730.There was a certain correlation between the prealbumin and T,N and M stages of the tumor.Conclusion A nomogram containing the prealbumin can accurately predict the prognosis of ICC patients after radical hepatectomy.更多还原