The prognostic value of sarcopenia combined with hepatolithiasis in intrahepatic cholangiocarcinoma patients after surgery: A prospective cohort study
The prognostic value of sarcopenia combined with hepatolithiasis in intrahepatic cholangiocarcinoma patients after surgery: A prospective cohort study
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肌少症合并肝内胆管癌术后肝内胆管癌患者的预后价值：一项前瞻性队列研究。
DOI：
10.1016/j.ejso.2020.09.002
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发表时间：
2021-03-01
期刊：
影响因子：
3.8
通讯作者：
Chen, Gang
中科院分区：
文献类型：
--
作者：
Deng, Liming;Wang, Yi;Chen, Gang
简介：肝内胆管细胞癌（ICC）是第二常见的原发性肝癌，生存率低。本研究旨在探讨肌肉减少症联合收割机与肝内胆管结石在手术治疗的ICC患者的预后价值，并制定一个预后列线图，以帮助临床decisions.Materials and Methods：前瞻性队列研究进行了包括2012年8月至2019年10月期间接受肝切除术的ICC患者。采用Kaplan-Meier（K-M）法研究肌少症合并肝内胆管结石与生存期（包括总生存期（OS）和无复发生存期（RFS））之间的关系。单因素和多因素考克斯回归分析确定独立的预后因素，并进行诺模图进行多因素分析的基础上。K-M分析显示，ICC患者合并肌肉减少症和肝内胆管结石者的OS和RFS显著低于无肌肉减少症和/或肝内胆管结石者（P < 0.01）。多因素分析显示，年龄、血清CEA、肝内胆管结石、肌肉减少症和糖尿病是影响OS的独立预后因素（p < 0.05）。最后，建立了一个具有良好生存预测性能的诺模图（C指数为0.721，OS曲线下面积为0.837）。根据列线图分层分析，高危组中位OS为11.9个月，低危组中位OS为51.2个月（P < 0.001）。我们开发的列线图是一种实用的工具，可以为手术治疗的ICC患者提供更个性化的风险评估。(C)2020年爱思唯尔有限公司，BASO -癌症外科协会和欧洲外科肿瘤学会。All rights reserved.
Introduction: Intrahepatic Cholangiocarcinoma (ICC) is the second most common primary liver cancer with dismal survival rates. This study aimed to explore the prognostic value of sarcopenia combine with hepatolithiasis in surgically treated ICC patients and develop a prognostic nomogram to help make clinical decisions.Materials and methods: A prospective cohort study was conducted including patients who underwent hepatectomy for ICC between August 2012 and October 2019. The association between the sarcopenia combined with hepatolithiasis and survival, including overall survival (OS) and recurrence-free survival (RFS) was investigated using the Kaplan-Meier (K-M) method. Univariable and multivariable Cox regression analysis was performed to determine the independent prognostic factors and a nomogram establishment was undertaken based on the multivariable analysis.Results: A total of 121 ICC patients were included in the study. K-M analysis revealed that ICC patients with sarcopenia and hepatolithiasis have worse OS and RFS than those without sarcopenias and/or hepatolithiasis (p < 0.01). Multivariable analysis showed that age, serum CEA, hepatolithiasis, sarcopenia and diabetes were independent prognostic factors for OS(p < 0.05). Finally, a nomogram with good performance in survival prediction was established (C-index was 0.721; the area under the curve of OS was 0.837). The stratified analysis based on the nomogram disclosed that the median OS was 11.9 months in high-risk patients and 51.2 months in low-risk patients (p < 0.001).Conclusions: ICC patients with sarcopenia and hepatolithiasis have worse OS and RFS. The nomogram we developed is a practical tool that can provide a more individualized risk assessment for surgically treated ICC patients. (C) 2020 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.