Tan Xinyu, Xiao Ke, Liu Wei, Chang Shi, Zhang Tian, Tang Huihuan
Hepatogastroenterology. 2013 Nov-Dec;60(128):1892-5.
BACKGROUND/AIMS: The aim of this study was to identify useful prognostic factors for patients with distal cholangiocarcinoma.
The records of 84 patients with distal cholangiocarcinoma undergoing pancreatoduodenectomy were retrospectively reviewed. Potential clinicopathological prognostic factors that may affect survival were examined by univariate and multivariate analyses.
There were two patients died within 30 days of surgery. Overall survival rates were 69.51%, 42.68%, and 36.59% for 1, 3 and 5 years, respectively (median survival time, 32.74 months). Univariate analysis found that alanine aminotransferase/aspartate aminotransferase (AST/ALT) ratio less than and equal to 2, serum bilirubin less than and equal to 171 micromol/L, CA19-9 level less than 150 U/L, tumor size less than 2 cm, absent neural invasion, and absent lymph node involvement were associated with higher survival rate (p < 0.05). Furthermore, multivariate analysis found that AST/ALT ratio more than 2, present lymph node involvement and present neural invasion were the independent risk factors of poor survival (p < 0.01).
These results suggest that not only the well-known lymph node involvement, but also neural invasion and AST/ALT ratio more than 2 might be useful prognostic factors for long-term survival in distal cholangiocarcinoma.
背景/目的：本研究旨在确定远端胆管癌患者有用的预后因素。
回顾性分析84例行胰十二指肠切除术的远端胆管癌患者的病历。通过单因素和多因素分析研究可能影响生存的潜在临床病理预后因素。
2例患者在术后30天内死亡。1年、3年和5年的总生存率分别为69.51%、42.68%和36.59%（中位生存时间为32.74个月）。单因素分析发现，丙氨酸氨基转移酶/天冬氨酸氨基转移酶（AST/ALT）比值小于等于2、血清胆红素小于等于171μmol/L、CA19-9水平小于150 U/L、肿瘤大小小于2 cm、无神经侵犯和无淋巴结转移与较高的生存率相关（p<0.05）。此外，多因素分析发现，AST/ALT比值大于2、存在淋巴结转移和存在神经侵犯是生存不良的独立危险因素（p<0.01）。
这些结果表明，不仅众所周知的淋巴结转移，而且神经侵犯和AST/ALT比值大于2可能是远端胆管癌长期生存的有用预后因素。
