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背景胆道系统恶性肿瘤包括胆管癌和胆囊癌,虽可行外科切除,但其仍为高病死率的侵袭性肿瘤。我们研究的目标是寻找预测术后生存率的指标。方法回顾性分析所有进行了根治性切除的胆道系统恶性肿瘤的患者。收集患者影像、CA19-9升高(>35U/ml)、治疗方法及治疗结果等资料,根据肿瘤位置不同进行比较分析。建立Kaplan-Meier生存曲线,采用log-rank检验,运用Cox比例风险回归进行多因素分析。结果 1992年至2007年间共91名胆道恶性肿瘤患者进行了外科手术切除。其中46名(50.5%)为肝外胆管癌(EHC),23名(25.2%)为肝内胆管癌(IHC),22名(24.2%)为胆囊癌(GBC)。中位年龄为64岁(24～92岁)。其中CA19～9升高患者数为45名(55%)(52%IHC,63%EHC,41%GBC)。总体中位生存时间为22.5(0.3～153.3)月。三组均具类似年龄、性别、术前CA19-9水平、切除彻底性和肿瘤病理组织学特征构成。中位数存活期最短为GBC(14.3月),其次为EHC(24.8月),IHC(30.4月),然而其并不具统计学意义(P=0.971)。通过单变量分析(15.1月,P=0.003)和多因素分析(67.4月,P=0.047)提示只有术前升高的CA19-9水平(>35U/ml)预测不良的中位生存时间。结论术前CA19-9水平升高是胆道恶性肿瘤患者术后较差生存的独立危险因素。因此我们建议术前常规检测CA19-9水平。
Background Biliary system malignancies, including cholangiocarcinoma and gallbladder cancer, are feasible surgical resections, but they remain aggressive tumors of high mortality. The goal of our research is to find indicators that predict postoperative survival. Methods A retrospective analysis of all patients who underwent radical resection of biliary system malignancies. The images of patients, elevated CA19-9 (> 35U / ml), treatment methods and treatment results were collected and compared according to the tumor location. Kaplan-Meier survival curves were established, using log-rank test and multivariate analysis using Cox proportional hazards regression. Results A total of 91 patients with biliary malignancy underwent surgical resection between 1992 and 2007. Of these, 46 (50.5%) had extrahepatic cholangiocarcinoma (EHC), 23 (25.2%) had intrahepatic cholangiocarcinoma (IHC) and 22 (24.2%) had gallbladder cancer (GBC). The median age was 64 (24-92 years). The number of patients with elevated CA19-9 was 45 (55%) (52% IHC, 63% EHC, 41% GBC). The median overall survival time was 22.5 (0.3 ~ 153.3) months. Three groups were similar to age, gender, preoperative CA19-9 levels, thorough resection and histopathological features of the tumor. The median survival was shortest for GBC (14.3 months), followed by EHC (24.8 months) and IHC (30.4 months), however, it was not statistically significant (P = 0.971). Univariate analysis (15.1 months, P = 0.003) and multivariate analysis (67.4 months, P = 0.047) suggested that only preoperatively elevated CA19-9 levels (> 35 U / ml) predicted poor median survival. Conclusions The preoperative CA19-9 level is an independent risk factor for postoperative poor survival in patients with biliary malignancies. Therefore, we recommend preoperative routine detection of CA19-9 levels.