| Objective:To investigate the clinical and pathological features of intrahepatic cholangiolith-iasis complicated with cholangiocarcinoma and to establish a prognostic model of intrahepatic cholangiocarcinoma by analyzing the clinical data.Methods:Retrospective analysis was performed on patients with intrahepatic cholangiocar-cinoma confirmed by postoperative pathology after surgical treatment in the First Affiliated Hospital of Nanchang University from 2010 to 2021.Patients were screened according to inclusion and screening conditions,among which patients with intrahepatic bile duct calculi were in group T and patients with simple intrahepatic bile duct carcinoma were in group C.The clinical and pathological characteristics of the two groups were statistically analyzed.Results:A total of 98 patients were enrolled,including 47 males(48.0%)and 51 females(52%),with a median age of 59 years(36-83 years),including 48 patients in group T and 50 patients in group C.The basic clinical information of abdominal pain,fever,history of cholecystectomy and hepatitis B were significantly different between the two groups(P< 0.05).The incidence of abdominal pain(89.6%,43/48),fever(35.4%,17/48)and history of cholecystectomy(45.8%,22/48)in group T was higher than that in group C,while the incidence of hepatitis B in group C was higher than that in group T(30.0%,15/50).The results of laboratory examination showed that the level of high density lipoprotein(HDL,1.22±0.45mmol/L)in group C was higher than that in group T(0.96±0.43mmol/L),the difference was statistically significant(P< 0.05).Platelet-lymphocyte ratio(PLR)was significantly different between the T and C groups(83.3% vs 60.0%,P< 0.05).Among the pathological features of tumors,all patients in group T had bile duct stenosis,while 58% of patients in group C had bile duct stenosis.The incidence of cirrhosis was higher in group T than in group C(43.8% vs 10%,P< 0.05),in addition,patients in the T group were more likely to have nerve invasion than those in the C group(54.2% vs 28.0%,P<;0.05).The median survival time of the T group was 15.8 months and that of the C group was24.1 months,indicating a significant difference in survival between the two groups(P< 0.05).Further analysis of the factors influencing the survival and prognosis of intrahepatic bile duct calculus combined with cholangiocarcinoma showed that the risk factors for OS were alcohol consumption(hazard ratio: 4.149,95% confidence interval: 1.316-13.084),CA19-9(1.001,1.000-1.001),CA125(1.015,1.007-1.022),CEA(1.005,1.002-1.009),N stage(9.436,3.497-25.461),TNM staging(2.987,1.538-5.799)and lymph node dissection(2.638,1.332-5.223).Multivariate Cox analysis showed that the independent risk factors for OS were tumor N stage(6.78,1.70-27.04).Factors such as sex,age,CA19-9,alcohol consumption and TNM stage of tumor were combined to construct a column graph,and the calibration curve showed that the prediction effect was good.Conclusions:Compared with iCCA patients,HICC patients are more likely to present clinical symptoms such as abdominal pain and fever,and most HICC patients have a history of cholecystectomy,and the inflammatory index PLR is higher than that of iCCA patients,while the incidence of hepatitis B in iCCA patients is higher than that of HICC patients.This may suggest that the pathogenesis of HICC is different.HICC is caused by repeated inflammatory stimulation caused by intrahepatic bile duct stones,which leads to abnormal differentiation of bile duct cells and eventually leads to the formation of tumors,while iCCA is less likely to be caused by inflammation caused by stones,and more likely to be caused by hepatitis B virus.Compared with iCCA,HICC has a worse survival prognosis and is more likely to invade nerves and produce bile duct stenosis.Lymph node metastasis were independent risk factors for prognosis of HICC. |
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