Ma Ling, Qiu Jinrong, Zhang Yaodong, Qiu Tianzhu, Wang Biao, Chen Wensen, Li Xiao, Sun Jing, Wang Ke, Li Xiangcheng, Gu Yanhong, Shu Yongqian, Chen Xiaofeng
Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Department of Biological Therapy, Eastern Hepatobiliary Surgery Hospital Affiliated to Second Military Medical University, Shanghai, People's Republic of China.
Onco Targets Ther. 2018 May 4;11:2533-2543. doi: 10.2147/OTT.S150502. eCollection 2018.
Biliary tract cancers (BTCs) are uncommon but fatal, with a low 5-year survival rate after surgical resection. This study was designed to investigate the prognostic factors for operable BTC.
Baseline demographics at diagnosis were retrospectively evaluated in 341 BTC patients undergoing radical surgery at The First Affiliated Hospital of Nanjing Medical University from January 2011 to December 2015. The association between prognostic factors and overall survival (OS) was determined by multivariate analysis using the Cox proportional hazards regression model.
Our study showed that 341 patients were included in the analysis, of which 166 (48.7%) were males and 175 (51.3%) were females. Older age, depth of tumor invasion, positive surgical margin, lower hemoglobin, and higher lactic dehydrogenase (LDH) were associated with significantly worse OS using multivariate analysis. In the entire cohort, the estimate of median OS in patients with LDH <271 U/L was 36.291 months (95% CI; 30.989-41.594 months), and 30.736 months (95% CI; 19.154-42.318 months) in patients with LDH ≥271 U/L (adjusted HR-1.505, 95% CI; 1.009-2.245, = 0.045). Moreover, it was investigated whether serum LDH retained its significance as a prognostic marker in BTC subgroups separately. The results showed that LDH was prognostic in patients with distal bile duct (DBD) carcinoma undergoing radical surgery (HR-2.452, 95% CI; 1.167-5.152, = 0.018). However, there were no statistical differences between LDH and OS in multivariate analysis in the other three individual subgroups except for DBD carcinoma. This may be due to the limited number of patients in the study, indicating that a greater number of patients may be required for statistical significance.
Older age, depth of tumor invasion, positive surgical margin status, lower hemoglobin levels, and elevated serum LDH level are associated with poor survival in operable BTC patients. Serum LDH level is a cost-effective prognostic biomarker in patients with operable BTC and especially DBD carcinoma.
胆管癌（BTCs）虽不常见但致命，手术切除后的5年生存率较低。本研究旨在调查可手术切除的BTC的预后因素。
回顾性评估2011年1月至2015年12月在南京医科大学第一附属医院接受根治性手术的341例BTC患者诊断时的基线人口统计学资料。使用Cox比例风险回归模型通过多变量分析确定预后因素与总生存期（OS）之间的关联。
我们的研究表明，341例患者纳入分析，其中男性166例（48.7%），女性175例（51.3%）。多变量分析显示，年龄较大、肿瘤浸润深度、手术切缘阳性、血红蛋白水平较低以及乳酸脱氢酶（LDH）水平较高与OS显著较差相关。在整个队列中，LDH<271 U/L患者的中位OS估计值为36.291个月（95%CI：30.989 - 41.594个月），而LDH≥271 U/L患者为30.736个月（95%CI：19.154 - 42.318个月）（调整后HR = 1.505，95%CI：1.009 - 2.245，P = 0.045）。此外，还分别研究了血清LDH在BTC亚组中作为预后标志物是否仍具有意义。结果显示，LDH在接受根治性手术的远端胆管（DBD）癌患者中具有预后意义（HR = 2.452，95%CI：1.167 - 5.152，P = 0.018）。然而，除DBD癌外，在其他三个个体亚组的多变量分析中，LDH与OS之间无统计学差异。这可能是由于研究中的患者数量有限，表明可能需要更多患者才能达到统计学显著性。
年龄较大、肿瘤浸润深度、手术切缘阳性状态、血红蛋白水平较低以及血清LDH水平升高与可手术切除的BTC患者的生存不良相关。血清LDH水平是可手术切除的BTC患者尤其是DBD癌患者具有成本效益的预后生物标志物。
