【摘要】 目的 探讨肝细胞癌(HCC)和肝内胆管腺癌(ICC)患者临床病理特征对预后的影响。方法 纳入监测、流行病学和最终结果数据库2010年至2015年病理确诊的肝癌患者19 095例，统计患者2、3、5 a总生存率，并进行HCC、ICC预后影响因素的单因素和多因素分析。结果 HCC组和ICC组2 a总生存率分别为44.5%和32.2%(P<0.001),3 a总生存率分别为35.6%和21.7%(P<0.001),5 a总生存率分别为34.6%和20.4%(P<0.001),中位生存时间分别为16个月和11个月。多因素COX回归模型分析显示，HCC组中性别(HR:1.074,95%CI:1.004～1.149,P=0.037)、年龄(HR:0.932,95%CI:0.879～0.988,P=0.019)、人种(HR:1.075,95%CI:1.012～1.142,P=0.018)、分化程度(HR:0.656,95%CI:0.608～0.707,P<0.001)、T分期(HR:0.787,95%CI:0.707～0.876,P<0.001)、N分期(HR:0.869,95%CI:0.790～0.956,P=0.004)、M分期(HR:0.656,95%CI:0.599～0.717,P<0.001)、临床分期(HR:0.636,95%CI:0.563～0.718,P<0.001)、手术(HR:4.461,95%CI:4.143～4.804,P<0.001)和化疗(HR:1.748,95%CI:1.649～1.853,P=0.019)均为独立预后影响因素。ICC组中性别(HR:1.329,95%CI:1.161～1.521,P<0.001)、年龄(HR:0.778,95%CI:0.666～0.909,P=0.002)、分化程度(HR:0.743,95%CI:0.634～0.776,P<0.001)、临床分期(HR:0.606,95%CI:0.474～0.776,P<0.001)、手术(HR:4.611,95%CI:3.856～5.515,P<0.001)和化疗(HR:2.002,95%CI:1.720～2.330,P<0.001)均为独立预后影响因素。结论 ICC比HCC生存预后差，两者的预后影响因素存在差异，临床治疗应当分别对待。更多还原

【Abstract】 Objective To explore the influence of clinicopathological characteristics on prognosis of patients with hepatocellular carcinoma(HCC) and intrahepatic cholangiocarcinoma(ICC). Methods In surveillance, epidemiology, and end result program database from 2010 to 2015, a total of 19 095 patients with liver cancer were diagnosed pathologically. The 2-year, 3-year and 5-year overall survival rates were calculated. Prognosis factors were evaluated by using univariate factor and multivariate analysis. Results The 2-year overall survival rates of the HCC group and the ICC group were 44.5% and 32.2%, respectively(P<0.001); the 3-year overall survival rates of the two group were 35.6% and 21.7%, respectively(P<0.001); the 5-year overall survival rates of the two group were 34.6% and 20.4%, respectively(P<0.001); the median overall survival were 16 and 11 months. Multivariate COX regression analysis showed that gender(HR:1.074,95% CI: 1.004-1.149, P=0.037)、age(HR:0.932,95% CI:0.879-0.988, P=0.019)、race(HR:1.075,95% CI: 1.012-1.142, P=0.018) 、degree of differentiation(HR:0.656,95% CI:0.608-0.707, P<0.001)、T stage(HR:0.787,95% CI:0.707-0.876, P<0.001)、N stage(HR:0.869,95% CI:0.790-0.956, P=0.004)、M stage(HR:0.656,95% CI:0.599-0.717, P<0.001)、clinical stage(HR:0.636,95% CI:0.563-0.718, P<0.001)、operation(HR:4.461,95% CI:4.143-4.804, P<0.001) and chemotherapy(HR:1.748,95% CI:1.649-1.853, P=0.019)in the HCC group was the prognostic factors; while the gender(HR: 1.329, 95% CI: 1.161-1.521, P<0.001), age(HR: 0.778, 95% CI: 0.666-0.909, P= 0.002), degree of differentiation(HR: 0.743, 95% CI: 0.634-0.776, P<0.001), clinical stage(HR: 0.606, 95% CI: 0.474-0.776, P<0.001), operation(HR: 4.611, 95% CI: 3.856-5.515, P<0.001) and chemotherapy(HR: 2.002, 95% CI: 1.720-2.330, P<0.001) in the ICC group were the prognostic factors. Conclusion The prognosis of ICC is worse than HCC, the prognostic factors of HCC and ICC are different, clinical treatment should be treated separately.更多还原