Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
Department of Gastroenterology, Graduate School of Medicine, Juntendo University, Tokyo, Japan.
J Gastroenterol. 2018 Jul;53(7):854-860. doi: 10.1007/s00535-017-1410-6. Epub 2017 Nov 8.
Hepatolithiasis frequently results in severe complications. We conducted a cohort study to identify prognostic factors and to establish a hepatolithiasis severity classification system.
The study cohort comprised 396 patients who were identified through a 1998 nationwide survey and followed up for 18 years or until death. Cox regression analysis was used to identify prognostic factors.
Median survival time of the patients was 308 (range 0-462) months. Of the 396 patients enrolled in the study, 118 (29.8%) died, most frequently from intrahepatic cholangiocarcinoma (25 patients, 21.2%). Age of ≥ 65 years at the time of initial diagnosis [hazard ratio (HR) 3.410], jaundice for ≥ 1 week during follow-up (HR 2.442), intrahepatic cholangiocarcinoma (HR 3.674), and liver cirrhosis (HR 5.061) were shown to be significant risk factors for death from any therapeutic course. The data led to a 3-grade disease severity classification system that incorporates intrahepatic cholangiocarcinoma and liver cirrhosis as major factors and age of ≥ 65 years and jaundice for ≥ 1 week during follow-up as minor factors. Survival rates differed significantly between grades.
The proposed hepatolithiasis severity classification system can be used to assess prognosis and thereby improve patient outcomes.
肝内胆管结石常导致严重并发症。我们进行了一项队列研究，以确定预后因素并建立肝内胆管结石严重程度分类系统。
该研究队列包括通过 1998 年全国性调查确定的 396 例患者，并进行了 18 年的随访或直至死亡。采用 Cox 回归分析确定预后因素。
患者的中位生存时间为 308（0-462）个月。在纳入研究的 396 例患者中，118 例（29.8%）死亡，最常见的死亡原因为肝内胆管细胞癌（25 例，21.2%）。初诊时年龄≥65 岁（风险比[HR]3.410）、随访期间黄疸持续≥1 周（HR 2.442）、肝内胆管细胞癌（HR 3.674）和肝硬化（HR 5.061）是从任何治疗方案中死亡的显著危险因素。这些数据导致了一种 3 级疾病严重程度分类系统，将肝内胆管细胞癌和肝硬化作为主要因素，年龄≥65 岁和随访期间黄疸持续≥1 周作为次要因素。不同等级的生存率差异显著。
提出的肝内胆管结石严重程度分类系统可用于评估预后，从而改善患者结局。
