Analysis Of The Factors Influencing The Prognosis OfSurgical Treatment For The Patients Withhilar Cholangiocarcinoma

Objective:To analyze the clinic data and the follow-up suivival data of 108 hilar chol angiocarcinoma patients undergoing surgical treatment in the first affiliated hosp ital,Kunming Medicical Univerty from 2004-01 to 2015-12.Discuss the factors i nfluencing the prognosis of surgical treatment for hilar cholangiocarcinoma to p rovide some suggetions for the surgical treatment for the patients with the hilar cholangicarcinoma.Methods:This study collects the clinical and pathological data of 108 patients with h ilar cholangiocarcinoma,undergoing surgical treatment in the first affiliated hospi tal of Kunming Medicical Univerty from 2004-01 to 2015-12.They are groupe by the age,the sex,the preoperative total bilirubin level,the preoperative albumi n level, the preoperative Child-Pugh grade of the liver function, the preoperativ e CA199 level,the preoperative CEA level,tthe Bismuth-Corlette type,the stage o f AJCCTNM-staging,the stage of the modified T staging,the histological classfic ation,the operative method,the condition of the lymph node metastasis and the condition of the portal vein invasion.This study analyzes these grouping basis a s variables. This study retrospectively analyzes the clinical characteristic data,th e data of the surgical treatment procedure and the telephone or outpatient follo w-up data by using Kaplan-Meier method.This study uses the Kaplan-Meier pro duct-limit method to evalute the survival rate and the survival time and uses t he Log-Rank test method to analyze 16 variables.The variables showing statisti cal significance in the Log-rank test method are included in the following mult ivariate analysisusing Cox stepwise proportional hazard regression model.Results:Signal factor analysis:1、The result of the prognostic analysis in the different gender groups s hows that the differences of the survival time and rate between male group a nd female group are not statistically significant(P>0.05).2、The result of the prognostic analysis in the different age groups shows that the differences of the survival time and rate between≤60 years old group and>60 years old group are not statistically significant(P>0.05).3、The result of the prognostic analysis in the different preoperative tota 1 bilirubin level groups shows that the differences of the survival time and r ate among<170umol/L group,170-340umol/L group,>340umol/L group are not statistically significant(P>0.05).4、The result of the prognostic analysis in the different preoperative albu min level groups shows that the diffiences of the survival time and rate bet ween<35g/L group and≥35g/L group are not statistically significant(P>0.05).5、The result of the prognostic analysis in the different preoperative CA1 99 level groups shows that the differences of the survival rate between≤35 U/L group and>35U/L group are not statistically significant(P>0.05).6、The result of the prognostic analysis in the different preoperative C EA level shows groups that the differences of the survival time and rate betw een≤5U/Lgroup and>5U/L group are not statistically significant(P>0.05).7、The result of the prognostic analysis in the different preoperative Ch ild-Pugh grade of the liver function shows that the differences of the surviv al time and rate between Grade A group, Grade B group and Grade C group are not statistically significant(P>0.05).8、The result of the prognostic analysis in the different Bismuth-Corlett e type groups shows that the diffiences of the survival time and rate among typel group,type2 group,type3 group,and type4 group are not statistically signi ficant(P>0.05).9、The result of the prognostic analysis in the different stages of AJCC TNM-staging shows that the diffiences of the survival time and rate among 1 stageⅠ group,stageⅡ group,stageⅢ group and stage Ⅳ group are statistically si gnificant(P<0.05).10、The result of the prognostic analysis in the different stages of the m odified T staging show that the diffiences of the survival time and rate amon g T1 group,T2 group and T3 group are statistically significant(P<0.05).11、The result of the prognostic analysis in the different histlogical class fication groups shows that the differences of the survival time and rate amon g highly differentiated adenocarcinoma group,moderately differentiated adenocarc inoma group,poorly differentiated adenocarcinoma group and mucinous adenocar cinoma group are statistically significant(P<0.05).12、The result of the prognostic analysis in the different operative meth od groups shows that the differences of the survival time and rate among rad ical resection group,palliative resectiongroup,internal drainage group and extern al drainage group are statistically significant(P<0.05).13、The result of the prognostic analysis in the different groups of the c ondition of the lymph node metastasis shows that the differences of the surv ival time and rate between lymph node metastasis group and no lymph node metastasis group are statistically significant.(P<0.05).14、The result of the prognostic analysis in the different groups of the c ondition of the portal vein invasion shows that the differencens of the survi val time and rate between portal vein invasion group and no portal vein invasi on group are statistically significant (P<0.05). Multiple-factor analysis:The single factor analysis shows that the surgical method,the modified T sta ging,the histlogical classfication, the AJCCTNM-staging,the lymph node metasta sis and the portal vein invasion are the effective factors of the prognosis of th e patients with hilar cholangiocarcinoma undergoing the surgical treatment.The se factors are put into the COX proportional hazard regression model.The resul ts shows that the order of the importantances of these factors:the surgical met hod>the modified T staging>the AJCCTNM-staging>the histlogical classficati on>the lymph node metastasis>the portal vein invasion.Inclusion:1、The gender,the age,the preoperative total bilirubin level,the preoperative a lbumin level,the preoperative CA199 level, the preoperative CEA level,the preo perative Bismuth-Corlette type are not the factors influencing the prognosis of t he hilar cholangicarcinoma.2、The surgical method,the modified T staging,the histlogical classfication,the AJCCTNM-staging,the lymph node metastasis and the portal vein invasion are t he factors influencing the prognosis of the hilar cholangicarcinoma.3、These factors could be sorted by the priority:the surgical method>the mo dified T staging>the AJCCTNM-staging>the histlogical classfication>the lymp hnode metastasis>the portal vein invasion.4、The redical resection is the most important factor fluencing the prognosis of the hilar cholangicaroma.