COMTH评分对恶性胆管狭窄患者生存预后评估的回顾性研究

COMTH score for the survival of patients with malignant biliary stricture： a retrospective study

摘要:

目的 探讨仅接受ERCP和后续保守治疗的恶性胆管狭窄患者的自然病程、影响预后的危险因素，以及建立生存期预测模型，指导后续治疗。 方法 回顾性分析2009年1月至2013年12月期间在西京医院和解放军第四五一医院仅接受ERCP和保守治疗的恶性胆管狭窄患者的预后情况。测试队列确定与生存期相关的预测因子，并建立预测模型，在验证队列中进行验证。 结果 从2009年1月至2013年12月，共纳入301例患者，其中测试队列152例，验证队列149例。测试队列中，肿瘤主要起源于胆管（33.6％），胰腺（23.5％）或壶腹部（20.4％），76.3％（116／152）的患者在观察期内死亡，中位生存期为5（3.9～6.2）个月。CA19-9≥1 000 U／mL，非壶腹部起源肿瘤，肿瘤转移，术前总胆红素水平≥7 mg／dL以及肝门狭窄是预后不佳的独立预测因素。根据危险因素建立COMTH预测模型，在测试队列和验证队列中，COMTH评分＞8的患者中位生存期均为3.0个月，明显小于COMTH评分≤8的患者（分别为10.0和6.9个月，P值均＜0.001）。 结论 仅接受ERCP和后续保守治疗的恶性胆管狭窄患者的预后不佳，COMTH评分＞8提示生存期较短。

Abstract:

Objective To investigate the history，risk factors for prognosis of malignant biliary stricture （MBS） patients receiving conservative therapy after endoscopic retrograde cholangiopancreatography(ERCP) and to set up a predictive model for overall survival （OS）. Methods MBS patients who underwent ERCP and conservative therapy in Xijing Hospital and PLA No.451 Hospital from January 2009 to December 2013 were enrolled to the present study. Predictive factors associated with OS were identified in the training cohort by stepwise multivariate Cox regression analysis. A predictive model was then developed and externally validated in the validation cohort. Results Between January 2009 and December 2013， 152 and 149 patients were eligible to the training and validation cohort respectively. In the training cohort， tumors were mainly originated from bile duct （33.6％）， pancreas （23.5％） or ampulla （20.4％）. 76.3％ （116／152） patients died during the observation period. The median OS for the training population was 5.0 months （3.9-6.2 months）. CA19-9≥1 000 U／mL， non-ampulla tumor， metastasis， pre-ERCP total bilirubin≥7 mg／dL and hilar stricture were identified as independent predictive factors of poor OS （all P＜0.05）. Based on these factors， the COMTH predictive model was developed. The median OS of patients with COMTH＞8 in the training and validation cohorts were both 3.0 months， which were significantly shorter than those with COMTH≤8 （10.0 and 6.9 months in the training and validation cohorts respectively， both P＜0.001）. Conclusion The prognosis of MBS patients undergoing ERCP is poor. The survival chance of patients with COMTH＞8 is even more dismal.