通过倾向评分匹配分析评估肝内胆管癌中胆石的预后价值。
Evaluating prognostic value of biliary stone in intrahepatic cholangiocarcinoma by propensity score matching analysis.
作者信息
Wang Yupeng, Huang Ao, Guo Dezhen, Wang Jian, Chen Feiyu, Sun Huichuan, Qiu Shuangjian, Zhang Sunyue, Cao Ya, Yang Xinrong, Zhou Jian
机构信息
Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, 200437, China.
Key Laboratory of Carcinogenesis and Cancer Invasion, Fudan University, Shanghai, 200437, China.
出版信息
J Cancer. 2023 May 8;14(7):1257-1271. doi: 10.7150/jca.74275. eCollection 2023.
To explore biliary tract stone (BTS) as prognostic factors of intrahepatic cholangiocarcinoma (ICC). Clinical data of 985 ICC patients were classified into no BTS group and BTS group-subgrouped into hepatolithiasis (HL) and non-hepatolithiasis (NHL) group. Propensity score matching was utilized to mitigate baseline characteristics. Preoperative peripheral inflammation parameters (PPIP) were further investigated. Immunostaining of CD3, CD4, CD8, CD68, PD1 and PD-L1 were conducted. Overall survival (OS) of patients without BTS surpassed BTS group ( = 0.040) while no difference of time to recurrence (TTR) was observed ( = 0.146). HL group had shorter OS and TTR than HL-matched group ( < 0.001 and = 0.017, respectively) and survival time of NHL group differed not with NHL-matched group ( > 0.05). PPIP like neutrophils to lymphocytes ratio (NLR), platelet to lymphocyte ratio (PLR) and systemic immune inflammation (SII) of HL group exceeded no BTS group or NHL group (all < 0.05). Associations of PPIP and tumorous immunocytes differed vastly among HL group, NHL group and no BTS group. Tumorous CD4/CD3 ratio and PD1/CD3 ratio of HL group surpassed those in no BTS group ( = 0.036 and < 0.001, respectively) and NHL group ( = 0.015 and 0.002, respectively). Para-tumorous CD68 macrophages exceeded that in tumor samples of HL group ( < 0.001). No difference of CD8/CD3 lymphocyte ratio and PD-L1 rank were detected. Hepatolithiasis, rather than extra-hepatic biliary stone, is a poor prognostic indicator of ICC. Immunotherapy is promising in treating HL-related ICC.
探讨胆道结石（BTS）作为肝内胆管癌（ICC）的预后因素。将985例ICC患者的临床资料分为无BTS组和BTS组，后者再细分为肝内胆管结石（HL）组和非肝内胆管结石（NHL）组。采用倾向评分匹配法来平衡基线特征。进一步研究术前外周炎症参数（PPIP）。进行CD3、CD4、CD8、CD68、PD1和PD-L1的免疫染色。无BTS患者的总生存期（OS）超过BTS组（P = 0.040），而复发时间（TTR）无差异（P = 0.146）。HL组的OS和TTR短于HL匹配组（分别为P < 0.001和P = 0.017），NHL组的生存时间与NHL匹配组无差异（P > 0.05）。HL组的PPIP如中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）和全身免疫炎症（SII）超过无BTS组或NHL组（均P < 0.05）。HL组、NHL组和无BTS组中PPIP与肿瘤免疫细胞的关联差异很大。HL组的肿瘤CD4/CD3比值和PD1/CD3比值超过无BTS组（分别为P = 0.036和P < 0.001）和NHL组（分别为P = 0.015和P = 0.002）。HL组肿瘤旁CD68巨噬细胞超过HL组肿瘤样本中的（P < 0.001）。未检测到CD8/CD3淋巴细胞比值和PD-L1等级的差异。肝内胆管结石而非肝外胆管结石是ICC的不良预后指标。免疫治疗在治疗与HL相关的ICC方面具有前景。
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