Shinke Go, Yamada Daisaku, Eguchi Hidetoshi, Iwagami Yoshifumi, Akita Hirofumi, Asaoka Tadafumi, Noda Takehiro, Gotoh Kunihito, Kobayashi Shogo, Takeda Yutaka, Tanemura Masahiro, Doki Yuichiro, Mori Masaki
Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan.
Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan.
Mol Clin Oncol. 2019 May;10(5):531-540. doi: 10.3892/mco.2019.1827. Epub 2019 Mar 15.
Cholangiocarcinoma (CCA) is a lethal disease. A new predictive factor to identify patients suitable for adjuvant chemotherapy is needed. The relationship between the long-term prognosis and the perioperative immune responses in patients with CCA remains unclear. We therefore investigated the clinical impact of perioperative immune responses on the long-term prognosis in patients receiving hepatectomy for CCA. We investigated 81 patients who underwent hepatectomy between February 2000 and October 2012: 57 intra-hepatic CCA (iCCA) patients and 24 extra-hepatic CCA (eCCA) patients. We checked the postoperative level of C-reactive protein and the numbers of leukocytes. A multivariate analysis of the clinicopathological factors identified 2 significant risk factors for the overall survival: The postoperative maximum number of leukocytes (PNL) among patient factors (P=0.0406) and the TNM-stage among tumor factors (P=0.0059). On evaluating the distribution of each kind of leukocyte with a multivariate analysis, both the postoperative maximum number of neutrophils (PNN) and the postoperative maximum number of eosinophils (PNE) were detected as significant factors among leukocytes (PNN/PNE, P=0.0367/0.0083). In conclusion, the PNL after hepatectomy was significantly associated with the long-term prognosis in patients with CCA. Changes in the numbers of leukocytes after hepatectomy may be a marker on treatment for CCA.
胆管癌（CCA）是一种致命疾病。需要一种新的预测因素来识别适合辅助化疗的患者。CCA患者的长期预后与围手术期免疫反应之间的关系仍不清楚。因此，我们研究了围手术期免疫反应对接受CCA肝切除术患者长期预后的临床影响。我们调查了2000年2月至2012年10月期间接受肝切除术的81例患者：57例肝内CCA（iCCA）患者和24例肝外CCA（eCCA）患者。我们检查了术后C反应蛋白水平和白细胞数量。对临床病理因素进行多因素分析，确定了影响总生存的2个显著危险因素：患者因素中的术后白细胞最大数量（PNL）（P = 0.0406）和肿瘤因素中的TNM分期（P = 0.0059）。通过多因素分析评估各类白细胞的分布情况，术后中性粒细胞最大数量（PNN）和术后嗜酸性粒细胞最大数量（PNE）均被检测为白细胞中的显著因素（PNN/PNE，P = 0.0367/0.0083）。总之，肝切除术后的PNL与CCA患者的长期预后显著相关。肝切除术后白细胞数量的变化可能是CCA治疗的一个标志物。
