Miura Yuya, Ashida Ryo, Ohgi Katsuhisa, Yamada Mihoko, Kato Yoshiyasu, Otsuka Shimpei, Aramaki Takeshi, Kakuda Yuko, Uesaka Katsuhiko, Sugiura Teiichi
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
HPB (Oxford). 2024 Jun;26(6):800-807. doi: 10.1016/j.hpb.2024.02.015. Epub 2024 Feb 28.
This study aimed to develop a predictive score for intrahepatic cholangiocarcinoma (ICC) in patients without lymph node metastasis (LNM) using preoperative factors.
A retrospective analysis of 113 ICC patients who underwent liver resection with systemic lymph node dissection between 2002 and 2021 was conducted. A multivariate logistic regression analysis was used as a predictive scoring system for node-negative patients based on the β coefficients of preoperatively available factors.
LNM was observed in 36 patients (31.9%). Four factors were associated with LNM: suspicion of LNM on MDCT (odds ratio [OR] 13.40, p < 0.001), low-vascularity tumor (OR 6.28, p = 0.005), CA19-9 ≥500 U/mL (OR 5.90, p = 0.010), and tumor location in the left lobe (OR 3.67, p = 0.057). The predictive scoring system was created using these factors (assigning 3 points for suspected LNM on MDCT, 2 points for CA19-9 ≥500 U/mL, 2 points for low vascularity tumor, and 1 point for tumor location in the left lobe). A score cutoff value of 4 resulted in 0.861 sensitivity and a negative predictive value of 0.922 for detecting LNM. Notably, no patients with peripheral tumors and a score of ≤3 had LNM.
The developed scoring system may effectively help identify ICC patients without LNM.
本研究旨在利用术前因素为无淋巴结转移（LNM）的肝内胆管癌（ICC）患者制定一个预测评分。
对2002年至2021年间113例行肝切除及系统性淋巴结清扫的ICC患者进行回顾性分析。基于术前可用因素的β系数，采用多因素逻辑回归分析作为淋巴结阴性患者的预测评分系统。
36例患者（31.9%）出现LNM。四个因素与LNM相关：MDCT上怀疑有LNM（比值比[OR]13.40，p<0.001）、低血供肿瘤（OR 6.28，p = 0.005）、CA19-9≥500 U/mL（OR 5.90，p = 0.010）以及肿瘤位于左叶（OR 3.67，p = 0.057）。利用这些因素创建了预测评分系统（MDCT上怀疑有LNM得3分，CA19-9≥500 U/mL得2分，低血供肿瘤得2分，肿瘤位于左叶得1分）。评分临界值为4时，检测LNM的灵敏度为0.861，阴性预测值为0.922。值得注意的是，没有周围型肿瘤且评分≤3的患者出现LNM。
所开发的评分系统可能有效地帮助识别无LNM的ICC患者。
