| Objective: To analyze the prognosis of117Hilar Cholangiocarcinama patients whounderwent the treatment of surgery, then discuss the factors that effect its prognosis.Method: This retrospective analysis is comprised by informations of117HC patientswho underwent the diagnosis and treatment of surgery from1999to2012in theaffiliated second hospital of shanxi medical university and the tumor hospital ofshanxi province. We choose the survival analysis in medical statistics to analyze allvariables, these variables cover gender, age, preoperative total bilirubin, preoperativealbumin, test results of preoperative tumor markers CA199CA242CEA, surgicalprocedures pattern, lymph node metastasis, portal vein invasion, Bismuth-corlettetype, and histological classification, which may influence the prognosis. TheKaplan-Meier product-limited method estimates the survival rate and the Log-ranktest method is used to contrast the survival times of all the single fact. The markedand significant variables in the Log-rank test is analyzed by the multiple-factoranalysis. The multiple-factor analysis employ the Cox proportional hazardregression model to analyze and assess.Result:Single factor analysis:1. The compare by grouping sex shows that the differences of the median survivaltime between male and female are not statistic significance(P＞0.05).2. The compare by grouping age shows that the differences of the median survivaltime between≥60years and＜60years are not statistic significance(P＞0.05).3. The compare by grouping total bilirubin shows that the differences of the median survival time between≥170umol/L and＜170umol/L are not statistic significance(P＞0.05).4. The compare by grouping preoperative albumin value shows that the differences ofthe median survival time between≥35g/L and＜35g/are not statistic significance(P＞0.05).5. The compare by grouping test results of preoperative tumor markers shows that thedifferences of the median survival time between CA199＞35u/L and≤35u/L are notstatistic significance(P＞0.05),CA242＞35u/L and≤35u/L are not statisticsignificance(P＞0.05),CEA＞5u/Land≤5u/L are not statistic significance(P＞0.05).6. The compare by grouping A(radical resection group), B(palliative resection group),C(internal drainage group), D(external drainage group) shows that the totaldifferences of the median survival time between them are statistic significance (P＜0.05); The radical resection group(A) is longer the median survival time than otherthree groups’and its difference is statistic significance (P＜0.05);The median survivaltime of palliative resection group is longer than the internal drainage group andexternal drainage group respectively and the difference is statistic significance (P＜0.05); In the compare between the internal drainage group and the external drainagegroup, the differences of the median survival time is not statistic significance (P＞0.05).7. The compare by grouping Bismuth-corlette type (BⅠ,BⅡ,BⅢ,BⅣ)shows that thedifferences of the median survival time between them are not statistic significance(P＞0.05).The compare by grouping lymph node metastasis and not one shows that thedifferences of the median survival time between lymph node metastasis group and notlymph node metastasis group are statistic significance(P＜0.05).8. The compare by grouping lymph node metastasis and not one shows that the differences of the median survival time between lymph node metastasis group and notlymph node metastasis group are statistic significance(P＜0.05).9. The compare by grouping portal vein invasion and not one shows that thedifferences of the median survival time between portal vein invasion group and notportal vein invasion group are statistic significance(P＜0.05).10. The compare by grouping the histological classification including A(high or welldifferentiated adenocarcinoma group), B(moderately differentiated adenocarcinomagroup), C(poorly differentiated adenocarcinoma group), D(mucinous adenocarcinomagroup) shows that the total differences of the median survival time between them arestatistic significance(P＜0.05); The well differentiated adenocarcinoma group(A) islongest the median survival time than other three groups’ and its difference is statisticsignificance(P＜0.05);The median survival time of moderately differentiatedadenocarcinoma group(B) is longer than the other two groups respectively and thedifference is statistic significance (P＜0.05); In the compare between the poorlydifferentiated adenocarcinoma group and the mucinous adenocarcinoma group, thedifferences of the median survival time is not statistic significance (P＞0.05).Multiple-factor analysis:There are some independent factors to enter into the Cox proportional hazardregression model that includes the surgical approach, the lymph node metastasis andthe histological classification. They are the independent factors which could effect theprognosis of HC. If two facts about the lymph node metastasis and the histologicalclassification were constant, RR(the relative risk) of the surgical approach would be0.125,95%CI(confidence interval) for RR would be (1.540,5.815). It means that thesurgical approach is a protective factor. The efficacy of the radical resection group isbetter than the others including the alliative resection group, the internal drainagegroup and the external drainage group. The mortality risk of patient who accepts the no radical resection treatment are8times greater than one of patient who accepts theradical resection treatment. If two facts about the surgical approach and thehistological classification were constant, RR of the lymph node metastasis would be2.985,95%CI for RR would be （1.508,5.910）. It means that the mortality risk ofpatient who has the lymph node metastasis are2.5times greater than the one who hasnot the lymph node metastasis. If two facts about the surgical approach and the lymphnode metastasis were constant, RR of the histological classification would be2.992,95%CI for RR would be （1.540,5.815）. It means that the mortality risk of patientwho has the poorly differentiated adenocarcinoma are2.99times greater than the onewho has not the poorly differentiated adenocarcinoma including the mucinousadenocarcinoma and the high or well differentiated adenocarcinoma.Conclusion:1. The surgical procedures pattern, histological classification, lymphnode metastasis, and portal vein invasion in HC patient are the important factors ofinfluencing hilar cholangiocarcinoma patient’s prognosis;2. The prognosis of radicalresection is better than the others about palliative resection, internal drainage, andexternal drainage group, so it is preference to the adequate synthetical evaluationhilar cholangiocarcinoma patient... |
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