Clinical Characteristics and Prognostic Factors of Patients with Intrahepatic Cholangiocarcinoma with Fever: A Propensity Score Matching Analysis
Clinical Characteristics and Prognostic Factors of Patients with Intrahepatic Cholangiocarcinoma with Fever: A Propensity Score Matching Analysis
复制标题
伴发热的肝内胆管癌患者的临床特征和预后因素：倾向评分匹配分析。
DOI：
10.1634/theoncologist.2018-0268
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发表时间：
2019-07-01
期刊：
影响因子：
5.8
通讯作者：
Yang, Xin-Rong
中科院分区：
文献类型：
--
作者：
Gong, Zi-Jun;Cheng, Jian-Wen;Yang, Xin-Rong
背景肝内胆管细胞癌（ICC）患者很少以发热为首发症状。我们的目的是确定这些发热患者的临床特征和预后因素。受试者、材料和方法本研究回顾性分析了2002年1月至2014年12月在我院治疗的31例发热（>= 38. 0 ℃）ICC患者。倾向评分用于以1：2的比例匹配发热和非发热患者。结果与无发热的ICC患者相比，有发热的ICC患者血清γ-谷氨酰转移酶和癌胚抗原水平较高，肿瘤较大，肿瘤分化较差，预后较差（均P <0.05）。这得到了倾向评分匹配（PSM）分析的支持。单因素和多因素分析显示微血管浸润、肺门淋巴结转移和体温≥ 38.6 ℃与预后有关。伴有发热的ICC患者在PSM分析前后外周血中的白细胞、中性粒细胞、嗜中性粒细胞与淋巴细胞比率（NLR）和血小板与淋巴细胞比率（PLR）水平较高。体温与白细胞（r = 0.599，p <0.001）、中性粒细胞（r = 0.644，p <0.001）、NLR（r = 0.681，p <0.001）和PLR（r = 0.457，p = 0.010）呈正相关。结论发热>= 38.0 ℃和>= 38.6 ℃的ICC患者预后差，预后极差。根治性手术治疗可改善发热≥ 38.6 ℃的ICC患者的预后。实践意义肝内胆管细胞癌（ICC）患者以发热（>= 38.0 ℃）为首发症状是非常罕见的。由于他们的症状与肝脓肿相似，诊断具有挑战性，大多数患者在诊断时已经处于晚期。有发热的ICC与无发热的ICC有不同的临床特点，预后差。那些体温= 38.6摄氏度的预后非常糟糕，尽管他们都接受了根治性手术治疗。需要新的治疗策略来提高体温>= 38.6 ℃的ICC患者的生存率。
Background Patients with intrahepatic cholangiocarcinoma (ICC) rarely present fever as the initial symptom. We aimed to identify clinical characteristics and prognostic factors for these feverish patients. Subjects, Materials, and Methods This study retrospectively reviewed 31 patients with ICC with fever (>= 38.0 degrees C) treated at our hospital between January 2002 and December 2014. A propensity score was used to match patients with and without fever at a ratio of 1:2. Results Patients with ICC with fever had higher serum gamma-glutamyl transferase and carcinoembryonic antigen levels, larger tumors, poorer tumor differentiation, and worse prognosis (all p < .05) than those without fever. This was supported by propensity score matching (PSM) analysis. Univariate and multivariate analyses indicated that microvascular invasion, hilar lymph node metastasis, and temperature >= 38.6 degrees C were related to prognosis. Patients with ICC with fever had higher levels of leucocytes, neutrophils, neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) in peripheral blood before and after PSM analysis. Body temperature positively correlated with leucocytes (r = 0.599, p < .001), neutrophils (r = 0.644, p < .001), NLR (r = 0.681, p < .001), and PLR (r = 0.457, p = .010). Conclusion Patients with ICC with fever >= 38.0 degrees C and >= 38.6 degrees C had poor and extremely poor prognosis, respectively. Radical surgical treatment may improve the prognosis of patients with ICC with fever = 38.6 degrees C. Implications for Practice Patients with intrahepatic cholangiocarcinoma (ICC) with fever (>= 38.0 degrees C) as the initial symptom are extremely rare. Because their symptoms are similar to those of liver abscess, diagnosis is challenging, and most of these patients are already at an advanced stage at the time of diagnosis. Patients with ICC with fever had different clinical characteristics and worse prognosis than those without fever. The prognosis of those with temperature = 38.6 degrees C had an extremely dismal outcome, although they all received radical surgical treatment. New therapeutic strategies are needed to improve survival for patients with ICC with temperature >= 38.6 degrees C.