基于预后分析的肝内胆管癌肿瘤大小分型：一项回顾性多中心研究

doi:10.16139/j.1007-9610.2025.04.07

外科理论与实践 ›› 2025, Vol. 30 ›› Issue (04): 332-338.doi: 10.16139/j.1007-9610.2025.04.07

基于预后分析的肝内胆管癌肿瘤大小分型：一项回顾性多中心研究

陈嘉倩¹, 刘红枝¹, 孟令甜², 周伟平³, 程张军⁴, 楼健颖⁵, 郑树国⁶, 毕新宇⁷, 王剑明⁸, 郭伟⁹, 李富宇¹⁰, 王坚¹¹, 郑亚民¹², 李敬东¹³, 程石¹⁴, 黄尧¹, 曾永毅¹()

1.福建医科大学孟超肝胆医院肝胆外科，福建福州 350001
2.福州大学生物科学与工程学院，福建福州 350108
3.海军军医大学东方肝胆外科医院肝外三科，上海 200433
4.东南大学附属中大医院肝胆胰外科，江苏南京 210009
5.浙江大学医学院附属第二医院肝胆胰外科，浙江杭州 310009
6.陆军军医大学西南医院胆道外科，重庆 400038
7.中国医学科学院北京协和医学院肿瘤医院肝胆外科，北京 100021
8.华中科技大学同济医学院附属同济医院胆胰外科，湖北武汉 430030
9.首都医科大学附属北京友谊医院普通外科，北京 100050
10.四川大学华西医院胆道外科，四川成都 610041
11.上海交通大学医学院附属第六人民医院肝胆胰外科，上海 200233
12.首都医科大学宣武医院普通外科，北京 100053
13.川北医学院附属医院肝胆外科，四川南充 637000
14.首都医科大学附属北京天坛医院普通外科，北京 100070

收稿日期:2025-04-30 出版日期:2025-07-25 发布日期:2025-10-23
通讯作者: 曾永毅，E-mail: lamp197311@126.com
基金资助:
福建省卫生健康委员会中青年科研重大项目(2021ZQNZD013);福州市卫生健康科技创新平台项目(2021-S-wp1)

Intrahepatic cholangiocarcinoma tumor size classification based on prognostic analysis: a retrospective multicenter study

CHEN Jiaqian¹, LIU Hongzhi¹, MENG Lingtian², ZHOU Weiping³, CHENG Zhangjun⁴, LOU Jianying⁵, ZHENG Shuguo⁶, BI Xinyu⁷, WANG Jianming⁸, GUO Wei⁹, LI Fuyu¹⁰, WANG Jian¹¹, ZHENG Yamin¹², LI Jingdong¹³, CHENG Shi¹⁴, HUANG Yao¹, ZENG Yongyi¹()

1. Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fujian Fuzhou 350001, China
2. Fuzhou University, College of Biological Sciences and Engineering, Fujian Fuzhou 350108, China
3. Department of Hapatic Surgery Ⅲ, Eastern Hepatobiliary Surgery Hospital of Naval Medical University, Shanghai 200433, China
4. Department of Hepatobiliary and Pancreatic Surgery, Zhongda Hospital, Southeast University, Jiangsu Nanjing 210009, China
5. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang Hangzhou 310009, China
6. Department of Biliary Surgery, the Southwest Hospital of Army Medical University, Chongqing 400038, China
7. Department of Hepatobiliary Surgery, Cancer Hospital, Peking Union Medical University, Chinese Academy of Medical Sciences, Beijing 100021, China
8. Department of Biliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Hubei Wuhan 430030, China
9. Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
10. Department of Biliary Surgery, West China Hospital, Sichuan University, Sichuan Chengdu 610041, China
11. Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai 200233, China
12. Department of General Surgery, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
13. Department of Hepatobiliary Surgery, Affiliated Hospital of North Sichuan Medical College, Sichuan Nanchong 637000, China
14. Department of General Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China

Received:2025-04-30 Online:2025-07-25 Published:2025-10-23

摘要/Abstract

摘要：

目的：基于国内多中心临床病理数据进行回顾性分析，探讨肝内胆管癌（ICC）肿瘤大小分型与其预后的相关性，建立基于肿瘤大小的分型系统。方法：纳入2011年12月至2018年9月来自13家医院的280例ICC病人，采用最小P值法分析明确肿瘤大小的预后临界值，通过Kaplan-Meier法验证此分型在总生存率的效能。结果：共280例以最大径4 cm为界分为≤ 4 cm组、>4 cm组。通过多因素COX回归分析证实肿瘤大小分型是独立预后因素（HR=2.110，95% CI: 1.358~3.280）。结论：基于中国病人群体的肿瘤大小二分类系统方便有效地区分ICC的预后分层，为术后个性化辅助治疗、随访方案的选择提供了重要依据。

关键词: 肝内胆管癌, 肿瘤大小, 预后, 回顾性研究

Abstract:

Objective To retrospectively analyze multicenter data from domestic sources, aiming to explore the link between intrahepatic cholangiocarcinoma (ICC) tumor size and prognosis, establishing a classification system based on tumor size. Methods Between December 2011 and September 2018, 280 ICC patients from 13 hospitals were included. The tumor size prognosis cutoff was identified by the minimum P-value method, and the classification's overall survival related effectiveness was assessed by Kaplan-Meier analysis. Results All 280 patients were divided into the group of tumor maximum diameter ≤4 cm and >4 cm. Tumor size was confirmed as an independent prognosis factor by multivariate COX regression analysis (HR=2.110, 95% CI: 1.358-3.280). Conclusions The tumor size dichotomy classification system based on the Chinese patient group can expediently predict ICC prognosis and offers an important basis for selecting post-operative individualized adjuvant therapy and follow up plans.

Key words: Intrahepatic cholangiocarcinoma (ICC), Tumor size, Prognosis, Retrospective Study

中图分类号:

R735.7

陈嘉倩, 刘红枝, 孟令甜, 周伟平, 程张军, 楼健颖, 郑树国, 毕新宇, 王剑明, 郭伟, 李富宇, 王坚, 郑亚民, 李敬东, 程石, 黄尧, 曾永毅. 基于预后分析的肝内胆管癌肿瘤大小分型：一项回顾性多中心研究[J]. 外科理论与实践, 2025, 30(04): 332-338.

CHEN Jiaqian, LIU Hongzhi, MENG Lingtian, ZHOU Weiping, CHENG Zhangjun, LOU Jianying, ZHENG Shuguo, BI Xinyu, WANG Jianming, GUO Wei, LI Fuyu, WANG Jian, ZHENG Yamin, LI Jingdong, CHENG Shi, HUANG Yao, ZENG Yongyi. Intrahepatic cholangiocarcinoma tumor size classification based on prognostic analysis: a retrospective multicenter study[J]. Journal of Surgery Concepts & Practice, 2025, 30(04): 332-338.

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参考文献 32

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Cut-off (cm)	Log-rank OS P value	COX HR-OS(95% CI)
2	0.195	3.349（0.468-23.984）
3	0.010	2.253（1.185-4.283）
4	<0.001	2.190（1.414-3.394）
5	0.001	1.718（1.221-2.416）
6	0.003	1.625（1.174-2.251）
7	0.012	1.519（1.087-2.121）
8	0.062	1.402（0.976-2.013）
9	0.494	1.155（0.760-1.755）
10	0.191	1.333（0.860-2.068）
11	0.230	1.380（0.807-2.360）

Characteristics	≤4 cm（n=79）	>4 cm（n=201）	P value
Age （years）			0.219
≤60	42（53.2）	123（61.2）
>60	37（46.8）	78（38.8）
Gender			0.085
Male	57（72.2）	123（61.2）
Female	22（27.8）	78（38.8）
Hepatitis viral infection			0.014
No	34（43.0）	119（59.2）
Yes	45（57.0）	82（40.8）
ECOG score			0.120
<2	73（92.4）	172（85.6）
≥2	6（7.6）	29（14.4）
Child-Pugh score			0.453
A	51（64.6）	120（59.7）
B	28（35.4）	81（40.3）
CA19-9（μmol/L）			0.212
≤200	71（89.9）	169（84.1）
>200	8（10.1）	32（15.9）
CEA（μg/L）			0.943
≤5	61（77.2）	156（77.6）
>5	18（22.8）	45（22.4）
TBIL（μmol/L）			0.469
≤20	47（59.5）	110（54.7）
>20	32（40.5）	91（45.3）
Blood transfusion			0.059
No	72（91.1）	165（82.1）
Yes	7（8.9）	36（17.9）
Blood loss（mL）			0.721
≤400	64（81.0）	159（79.1）
>400	15（19.0）	42（20.9）
Anatomical liver resection			0.798
No	43（54.4）	106（52.7）
Yes	36（45.6）	95（47.3）
Microvascular invasion			0.781
No	72（91.1）	181（90.0）
Yes	7（8.9）	20（10.0）
Pathological classification			0.130
Non-mass	19（24.1）	67（33.3）
Mass	60（75.9）	134（66.7）
Histological classification			0.761
Non-adenocarcinoma	8（10.1）	18（9.0）
Adenocarcinoma	71（89.9）	183（91.0）
Satellite nodules			0.976
No	75（94.9）	191（95.0）
Yes	4（5.1）	10（5.0）
Neural invasion			0.869
No	69（87.3）	177（88.1）
Yes	10（12.7）	24（11.9）
Postoperative adjuvant therapy			0.153
No	67（84.8）	155（77.1）
Yes	12（15.2）	46（22.9）
Postoperative complications			0.630
No	60（75.9）	158（78.6）
Yes	19（24.1）	43（21.4）

Factors	Univariate			Multivariate
Factors	P value	HR	95% CI	P value	HR	95% CI
Age（>60 years）	0.835	1.036	（0.743-1.444）
Gender（Male）	0.370	1.172	（0.828-1.660）
Hepatitis viral infection	0.451	1.133	（0.818-1.569）
ECOG score（≥2）	<0.001	2.179	（1.436-3.306）	<0.001	2.192	（1.434-3.349）
Child-Pugh score（B）	0.141	1.278	（0.922-1.770）
CA19-9（>200 μmol/L）	0.081	1.520	（0.950-2.433）
CEA（>5 μg/L）	0.627	1.104	（0.741-1.645）
TBIL（>20 μmol/L）	0.539	1.107	（0.800-1.533）
Blood transfusion	0.393	0.806	（0.492-1.322）
Blood loss（>400 mL）	0.581	0.883	（0.569-1.372）
Anatomical liver resection	0.190	1.250	（0.895-1.745）
Microvascular invasion	0.021	1.794	（1.091-2.950）	0.014	1.875	（1.137-3.094）
Pathological classification（Mass）	0.021	0.676	（0.485-0.942）
Histological classification（Adenocarcinoma）	0.158	1.627	（0.828-3.197）
Satellite nodules	0.009	2.270	（1.224-4.213）	0.005	2.444	（1.130-4.560）
Neural invasion	0.640	1.137	（0.664-1.948）
Postoperative adjuvant therapy	0.614	0.896	（0.586-1.371）
Postoperative complications	0.149	1.331	（0.903-1.964）
Tumor maximum diameter（>4 cm）	<0.001	2.190	（1.414-3.394）	0.001	2.110	（1.358-3.280）

基于预后分析的肝内胆管癌肿瘤大小分型：一项回顾性多中心研究

Intrahepatic cholangiocarcinoma tumor size classification based on prognostic analysis: a retrospective multicenter study

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