肝内胆管癌患者根治性手术后肝衰竭和复发的术前危险因素分析OACSTPCD

Objective To predict the risk factors of postoperative liver failure and recurrence within 1 year for intrahepatic cholangiocarcinoma(ICC)patients who underwent radical resection based on preoperative clinical factors.Methods The clinical data of patients with ICC who underwent radical resection at the People's Hospital of Zhengzhou University from Jun.2017 to Jun.2022,were retrospectively analyzed.According to the postoperative liver function index,56 patients were divided into postoperative liver failure group(n=16)and non-liver failure group(n=40);According to the recurrence status within 1 year after radical resection,this 56 patients were divided into recurrence group(n=22)and non-recurrence group(n=34).Univariate analysis was used to explore risk factors for postoperative liver failure and recurrence within 1 year.The area under the receiver operating characteristic(ROC)curve(AUC)of serum creatinine to cystatin ratio(CCR)in predicting ICC recurrence within 1 year and postoperative liver failure were calculated.The value of CCR at the maximum Youden index was considered as the optimal cut-off point.Multivariate Logistic regression analysis was used to explore the independent risk factors for postoperative liver failure and recurrence within 1 year after radical resection.Results Univariate analysis shewed that there was significant difference in CCR between the recurrence group and non-recurrence group[(53.49±3.90)vs(72.46±2.10)],as well as between the liver failure group and non-liver failure group[(54.67±4.49)vs(69.14±2.48)](all P<0.05).Weight loss≥5 kg,hepatitis virus quantitation≥104 IU/ML,poor tumor differentiation,tumor maximum diameter≥5 cm,multiple tumor number,and lymph node metastasis were relevant factors for recurrence within 1 year after radical resection.Similarly,weight loss≥5 kg,hepatitis virus quantification≥104 IU/mL,tumor maximum diameter≥5 cm,multiple tumor number,and previous history of bile duct disease were identified as relevant factors for postoperative liver failure.ROC curve analysis showed that the AUCs were 0.814 and 0.720 for CCR in predicting recurrence and postoperative liver failure,respectively(all P<0.05);and the optimal cut-off points were 62.34 and 64.82,respectively.Multivariate Logistic regression analysis showed that low CCR(OR=22.357,95%CI 1.140-438.308),multiple tumor number(OR=27.050,95%CI 1.029-711.165),lymph node metastasis(OR=18.046,95%CI 1.029-711.165),and poor tumor differentiation(OR=18.134,95%CI 1.357-242.359)were independent risk factors for ICC recurrence within 1 year after radical resection.Tumor maximum diameter≥5 cm(OR=8.800,95%CI 2.373-32.635)was an independent risk factor for liver failure after radical resection.Conclusion For patients with ICC,CCR can be used as a preoperative clinical index to predict postoperative liver failure and recurrence within 1 year after radical resection.