非酒精性脂肪性肝病相关肝内胆管细胞癌的术后预后：一项多中心倾向评分匹配分析。

Postoperative Prognosis of Non-alcoholic Fatty Liver Disease-Associated Intrahepatic Cholangiocarcinoma: a Multi-center Propensity Score Matching Analysis.

机构信息

School of Medicine, Hepato-Pancreato-Biliary Center, Zhongda Hospital, Southeast University, Nanjing, 210009, China.

Department of Surgical Oncology, Qin Huai Medical District of Jinling Hospital, Nanjing Medical University, Nanjing, 210009, China.

出版信息

J Gastrointest Surg. 2023 Nov;27(11):2403-2413. doi: 10.1007/s11605-023-05794-7. Epub 2023 Aug 15.

DOI:10.1007/s11605-023-05794-7

PMID:37582919

Abstract

BACKGROUND AND AIMS

The incidence of intrahepatic cholangiocarcinoma (ICC) in non-alcoholic fatty liver disease (NAFLD) is increasing gradually. The prognosis of NAFLD-ICC has not been well studied. We aim to investigate the prognosis of patients with NAFLD-ICC after curative-intent partial hepatectomy (PH).

METHODS

Multi-center data from January 2003 to January 2014 were retrospectively analyzed. The prognosis of ICC was analyzed using PSM and compared with hepatitis B virus (HBV)-related ICC.

RESULTS

A total of 898 patients with ICC were included in this study. Of them, 199 (22.2%) were NAFLD-ICC, and 699 (77.8%) were HBV-ICC. Multivariate analysis showed that CA19-9 ≥ 37 U/mL, microvascular invasion, tumor size > 5 cm, multiple tumors, and lymph node (LN) metastasis were independent risk factors for early recurrence (ER) in ICC patients. After a 1:1 PSM, NAFLD-ICC has worse 5-year overall survival (OS) (24.0% vs. 48.9%), 5-year recurrence (80.9% vs. 55.0%), and ER (58.5% vs. 30.0%) than that of HBV-ICC (all P < 0.01). Multivariable analysis showed NAFLD was an independent risk factor for OS (hazard ratio [HR] 2.26, 95% CI 1.63-3.13, P < 0.001), tumor recurrence (HR 2.24, 95%CI 1.61-3.10, P < 0.001) and ER (HR 2.23, 95%CI 1.60-3.09, P < 0.001) in patients with ICC after PH. The sensitivity analysis indicated that NAFLD-ICC patients were more likely to experience ER.

CONCLUSION

Compared with HBV-ICC, NAFLD-ICC has a worse prognosis and was more likely to relapse early. More frequent surveillance should be considered.

摘要

背景与目的

非酒精性脂肪性肝病（NAFLD）相关的肝内胆管细胞癌（ICC）发病率逐渐增高。NAFLD-ICC 的预后尚未得到很好的研究。本研究旨在探讨行根治性部分肝切除术（PH）后 NAFLD-ICC 患者的预后。

方法

回顾性分析 2003 年 1 月至 2014 年 1 月多中心数据。采用 PSM 分析 ICC 的预后，并与乙型肝炎病毒（HBV）相关 ICC 进行比较。

结果

本研究共纳入 898 例 ICC 患者，其中 199 例（22.2%）为 NAFLD-ICC，699 例（77.8%）为 HBV-ICC。多因素分析显示，CA19-9≥37 U/ml、微血管侵犯、肿瘤直径＞5cm、多发病灶和淋巴结转移是 ICC 患者早期复发（ER）的独立危险因素。经 1:1 PSM 后，NAFLD-ICC 患者的 5 年总生存率（OS）（24.0% vs. 48.9%）、5 年复发率（80.9% vs. 55.0%）和 ER（58.5% vs. 30.0%）均差于 HBV-ICC（均 P<0.01）。多变量分析显示，NAFLD 是 OS（风险比[HR]2.26，95%CI 1.63-3.13，P<0.001）、肿瘤复发（HR 2.24，95%CI 1.61-3.10，P<0.001）和 ER（HR 2.23，95%CI 1.60-3.09，P<0.001）的独立危险因素。敏感性分析表明，NAFLD-ICC 患者更易发生 ER。