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目的确定术前CA19-9对肝门部胆管癌根治术患者预后判断最有价值的截点,并探讨肝门部胆管癌根治术患者预后的影响因素。方法来自第二军医大学东方肝胆外科医院行根治性手术治疗的肝门部胆管癌患者168例被纳入研究。首先分析术前血清CA19-9水平与肝门部胆管癌患者临床病理特征的关系,并应用ROC曲线法分析确认术前血清CA19-9水平对判断预后最有价值的截点;随后采用单因素模型分析预后的可能影响因素,进一步采用多因素模型分析得出预后的独立影响因素。结果术前血清CA19-9水平与肿瘤病理分期、有无淋巴结转移及肿瘤大小有关,术前血清CA19-9水平对预后判断最有价值的截点为150U/mL(P=0.000)。单因素模型分析显示年龄、肿瘤大小、分化程度、Bismuth-Corlette分型、门静脉侵犯、肝动脉侵犯、肝实质侵犯、术前减黄、淋巴结转移及切缘对预后有影响。多因素模型分析显示肿瘤分化程度、淋巴结转移、肝动脉侵犯、切缘及术前血清CA19-9水平仍然具有统计学意义,其OR值与95%置信区间分别为:3.359(1.440-7.837)、2.973(1.927-4.587)、2.096(1.271-3.455)、2.238(1.356-3.694)和2.954(1.890-4.618)。结论术前血清CA19-9是影响肝门部胆管癌根治术患者预后的独立影响因素,其对预后判断最有价值的截点是150U/mL;肿瘤分化程度、淋巴结转移、肝动脉侵犯及切缘也是肝门部胆管癌根治术患者预后的独立影响因素。
Objective To determine the most useful cut-off point for the prognosis of patients with hilar cholangiocarcinoma by preoperative CA19-9 and to explore the influencing factors of the prognosis of hilar cholangiocarcinoma. Methods A total of 168 patients with hilar cholangiocarcinoma undergoing radical surgery from the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University were enrolled. The relationship between preoperative serum CA19-9 level and clinicopathological features of patients with hilar cholangiocarcinoma was analyzed. The ROC curve analysis was used to confirm the preoperative serum CA19-9 level to determine the most valuable cut-off point for prognosis. Subsequently, single factor The model was used to analyze the possible influencing factors of prognosis, and the multivariate model was used to analyze the independent prognostic factors. Results The preoperative serum CA19-9 level correlated with the tumor pathological stage, lymph node metastasis and tumor size. The preoperative serum CA19-9 level had the most significant cut-off point of 150U / mL (P = 0.000). Univariate analysis showed that age, tumor size, degree of differentiation, Bismuth-Corlette classification, portal vein invasion, hepatic artery invasion, liver parenchymal invasion, preoperative reduction of yellow, lymph node metastasis and margins had an effect on prognosis. Multivariate model analysis showed that the degree of tumor differentiation, lymph node metastasis, hepatic artery invasion, margin and preoperative serum CA19-9 levels were still statistically significant, the OR and 95% confidence intervals were 3.359 (1.440-7.837), 2.973 (1.927-4.587), 2.096 (1.271-3.455), 2.238 (1.356-3.694) and 2.954 (1.890-4.618). Conclusions Preoperative serum CA19-9 is an independent factor influencing the prognosis of patients with hilar cholangiocarcinoma. The most valuable cut-off point for prognosis is 150U / mL. The degree of tumor differentiation, lymph node metastasis, hepatic artery invasion and dissection Margins are also independent prognostic factors in patients with hilar cholangiocarcinoma.