背景:本研究旨在探讨肝内胆管癌(ICC)患者的术前预后因素,并提出一种新的结合CA19-9和中性粒细胞/淋巴细胞比值(NLR)的ICC术前预后评分系统。
方法:在本回顾性分析中,研究了1728例诊断为ICC并接受根治性肝切除术的患者。这项研究采用单变量和多变量Cox回归来寻找影响复发和总生存期(OS)的因素。并进一步评估术前模型如何影响肿瘤特征和术后复发。
结果:多变量Cox回归分析结果表明,两个术前变量,NLR和Ca19-9是影响ICC患者术后复发和OS的独立危险因素。根据这些数据,将这两个因素分为0(NLR≤2.4和Ca19-9≤37U/ml)或1(NLR>2.4和Ca19-9>37U/ml),得出术前预后评分.根据评分模型,患者分为三组:0分(低风险组),1分(中等风险组),2分(高危人群)。三组的5年复发率和OS率为56.6%,68.2%,77.8%,和56.8%,40.6%,27.6%,分别,所有P值<0.001。此外,高危人群患者更容易出现早期复发(早期复发率高,中介-,低危人群占56.8%,51.5%,和37.1%,分别,P<0.001)和肝外转移(肝外转移率高,中介-,低风险人群为31.7%,26.4%,和15.4%,分别,P<0.001)。就肿瘤特征而言,高风险组患者肿瘤直径较大,更有可能出现微血管侵犯,淋巴结转移,和神经周侵犯。
结论:合并NLR和CA19-9水平的术前评分系统有效地捕获了ICC患者术后复发率和OS率的预测能力。
BACKGROUND: This study aims to investigate preoperative prognostic factors available for intrahepatic cholangiocarcinoma (ICC) patients and propose a new preoperative prognostic scoring system for ICC that combines CA19-9 and neutrophil/lymphocyte ratio (NLR).
METHODS: In this retrospective analysis, 1728 patients diagnosed with ICC and undergoing curative liver resections were studied. This study employed univariate and multivariate Cox regression to find factors affecting recurrence and overall survival (OS), and furthermore assessed how preoperative models influenced tumor traits and postoperative recurrence.
RESULTS: The results of the multivariate Cox regression analysis indicated that two preoperative variables, NLR and Ca19-9, were independent risk factors affecting postoperative recurrence and OS in ICC patients. Based on this data, assigning a score of 0 (NLR ≤ 2.4 and Ca19-9 ≤ 37U/ml) or 1 (NLR > 2.4 and Ca19-9 > 37U/ml) to these two factors, a preoperative prognostic score was derived. According to the scoring model, patients were divided into three groups: 0 points (low-risk group), 1 point (intermediate-risk group), and 2 points (high-risk group). The 5-year recurrence and OS rates for the three groups were 56.6%, 68.2%, 77.8%, and 56.8%, 40.6%, 27.6%, respectively, with all P values < 0.001. Furthermore, high-risk group patients were more prone to early recurrence (early recurrence rates for high-, intermediate-, and low-risk groups were 56.8%, 51.5%, and 37.1%, respectively, P < 0.001) and extrahepatic metastasis (extrahepatic metastasis rates for high-, intermediate-, and low-risk groups were 31.7%, 26.4%, and 15.4%, respectively, P < 0.001). In terms of tumor characteristics, high-risk group patients had larger tumor diameters and were more likely to experience microvascular invasion, lymph node metastasis, and perineural invasion.
CONCLUSIONS: The predictive capacity of postoperative recurrence and OS rates in ICC patients is effectively captured by the preoperative scoring system incorporating NLR and CA19-9 levels.