| ObjectivesCholangiocarcinoma is a malignant tumor originating from the epithelium of the bile duct.It is characterized by strong invasiveness and poor prognosis.The survival rate of five years after surgery is only 8-30%.The aim of this study is to summarize the clinical characteristics,clinicopathologic features and prognostic factors of the different parts of cholangiocarcinoma,and explore the risk factors of recurrence and survival of cholangiocarcinoma,so as to provide references for diagnosis and treatment of cholangiocarcinoma.MethodsThis study reviewed the clinical and pathological data of patients who underwent cholangiocarcinoma surgery in a single center from January 2010 to August 2017,finally 283 patients were included.All cases have imaging evidence and are pathologically diagnosed as adenocarcinoma of cholangiocarcinoma.30 clinicopathologic features and the survival period was analyzed.Kaplan-Meier analysis and log-rank test were used for univariate analysis.Multivariate analysis was performed by COX model.The data were analyzed by SPSS 21.0 statistical software,and P<0.05 was statistically significant.ResultsThe median survival period of cholangiocarcinoma was 19 months,and the survival rate of 1,2,and 3 years after operation was 55.8%,29.7%,and 15.5%respectively.112 cases of intrahepatic bile duct cancer were included,the survival rate of 1,2,and 3 years after operation in the intrahepatic bile duct cancer was 43.8%,25.9%,11.6%.Multivariate analysis suggests pathological differentiation,RO resection,preoperative albumin level,preoperative CA19-9 level,Postoperative radiotherapy and chemotherapy(P<0.05)may be a risk factor for the prognosis of intrahepatic cholangiocarcinoma.Through single factor analysis model,results showed that there is no significant difference in survival time between lymph node dissection and non dissection(P=0.92).A total of 81 cases of hilar cholangiocarcinoma patients,1 years,2 years,3 years survival rate after operation was 59.3%,29.6%,13.6%respectively,the multivariate analysis result of high degree of differentiation,RO resection,postoperative adjuvant chemoradiotherapy and elevated bilirubin is a protective factor of hilar cholangiocarcinoma multi factors,smoking,portal vein invasion,and tumor with larger size is a risk factor for hilar cholangiocarcinoma(P<0.05).Statistics showed that the size of tumor might be a major factor of portal vein invasion(P=0.017),and whether portal invasion could significantly affect RO resection rate(P=0.011),but not correlated with lymph node metastasis(P=0.145).A total of 90 cases of distal bile duct cancer patients 1 years,2 years,3 years survival rate after operation was 67.8%,36.7%,22.2%respectively of which are non R0 resection,a low degree of differentiation,lymph node metastasis,age more than 60 years,cholangiocarcinoma of pancreatic segment and preoperative CA125 level is higher than 35U/ml(P<0.05)may be a risk factor for distal bile duct cancer.There was no significant difference in the survival time(P=0.281)and the recurrence time(P=0.457)between the cholangiocarcinoma of pancreatic segment and cholangiocarcinoma of middle Common bile duct segment.Statistical analysis showed that the survival time of distal cholangiocarcinoma as significantly longer than intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma(P = 0.040 and 0.019).There are differences between the three groups in the degree of differentiation,tumor size,hepatitis B infection,elevated bilirubin and thrombin time,but there are no significant differences in bile duct stones,lymph node transfer,preoperative albumin.ConclusionThe prognosis of cholangiocarcinoma was significantly higher than the prognosis of intrahepatic cholangiocarcinoma and hilar cholangiocarcinoma.Whether dissection lymph node had no significant effect on prognosis in intrahepatic cholangiocarcinoma.And tumor size may be a risk factor for invasion of the portal vein in hilar cholangiocarcinoma,and portal vein invasion will significantly reduce the RO resection rate.In distal cholangiocarcinoma Whipple have a higher RO resection rate than common bile duct resection.Independent of cancer site,all high risk patients accept postoperative adjuvant therapy benefited with significantly longer survival rates... |
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