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<p><b>OBJECTIVE</b>To explore the risk factors of vascular invasion in patients with early gastric cancer (EGC), and to investigate the influence of vascular invasion on the prognosis of EGC patients.</p><p><b>METHODS</b>From January 2014 to December 2015, 449 EGC patients underwent curative gastrectomy at the First Affiliated Hospital of Anhui Medical University, of whom 27 cases (6.0%) developed vascular invasion. Clinicopathological and follow-up data of EGC cases were analyzed retrospectively. The association between clinicopathological features and vascular invasion was analyzed by using the Chi-square test or Fisher exact test, and the independent risk factors influencing vascular invasion were identified with logistic regression. The influence of vascular invasion on overall survival was investigated with Kaplan-Meier curve. This study was approved by Ethics Committee of The First Affiliated Hospital of Anhui Medical University (No. 2018-03-12).</p><p><b>RESULTS</b>Of 449 EGC patients, 325 were males and 124 were females (ratio 2.6:1.0) with the mean age of (60.8±10.5) (27 to 87) years; 228 were diagnosed as T1a stage and 221 were diagnosed as T1b. Univariate analysis showed that incidence of vascular invasion in EGC patients with ulceration or scar was 8.4%(18/225), which was higher than 3.8%(9/234) in those without ulceration, and the difference was statistically significant (χ²=4.061, P=0.044). The incidence of vascular invasion in patients with low differentiated tumor was 8.8% (20/226), which was significantly higher than 3.1%(7/223) in those with middle-high differentiated tumor(χ²= 8.363, P=0.012). The incidence of vascular invasion in patients staging T1b was 10.9% (24/221), which was significantly higher than 1.3% (3/228) in those staging T1a (P=0.000); The incidence of vascular invasion in patients with lymph node metastasis was 27.3% (15/55), which was significantly higher than 3.0%(12/394) in those without lymph node metastasis (χ²=50.122, P=0.000). However, there were no significant associations of vascular invasion with gender, age, surgical type, multiple tumor, tumor deposit, tumor location and tumor size (all P > 0.05). Multivariate analysis showed that T1b stage (RR=4.653, 95%CI:1.293-16.747, P=0.019) and lymph node metastasis(RR=7.302, 95%CI: 3.063-17.408, P=0.000) were independent risk factors for vascular invasion in EGC patients. Among 449 EGC patients, 444 received complete follow-up(98.9%), including 26 cases with vascular invasion and 418 cases without vascular invasion. The overall survival in vascular invasion group was significantly lower than that in non-vascular invasion group (χ²=60.463, P=0.000). Besides, 198 EGC patients gained follow-up for 3 years, and the 3-year survival rates of 11 vascular invasion cases and 187 non-vascular invasion cases were 54.5% and 96.8% respectively.</p><p><b>CONCLUSIONS</b>The risk of vascular invasion is higher in EGC patients with lymph node metastasis and tumor infiltrating the submucosa. The prognosis of EGC patients with vascular invasion is poor.</p>
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Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Gastrectomy , Lymph Node Excision , Neoplasm Invasiveness , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Factors , Stomach Neoplasms , Pathology , General Surgery , Vascular NeoplasmsABSTRACT
Objective To assess the prognostic significance of prognostic nutritional index (PNI),neutrophil lymphocyte ratio (NLR) and platelet-lymphocyte ratio in gastric cancer patients.Methods Clinico-pathological data of 257 patients with gastric cancer in the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 was analyzed retrospectively.The ROC curve and Youden index were used to determine the cut-off value,survival curves were described by KaplanMeier method and compared by Log-rank test.The univariate and multivariate analyses were performed with the Cox proportional hazard model to identify the prognostic factors.Results PNI was positively correlated with ages,tumor size,depth of tumor invasion,TNM stages,albumin,pre-albumin and hemoglobin (all P ＜ 0.05).NLR was associated with the tumor size,the depth of invasion,lymph node metastasis,TNM stages,albumin,pre-albumin and hemoglobin (all P ＜ 0.05).PLR was associated with the tumor size,prealbumin and hemoglobin (all P ＜ 0.05).The Kaplan-Meier curves showed that gastric cancer patients had longer overall time in the low NLR group,low PLR group and high PNI group than in the high NLR group,high PLR group and low PNI group respectively (all P ＜ 0.05).The multivariate analyses showed that PNI and NLR were independent factors for predicting overall survival of gastric cancer patients.Conclusions PNI and NLR have more predictive value of overall survival than the PLR,PNI and NLR are independent prognostic factors of OS (overall survival) in gastric cancer.
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Objective To explore the independent risk factors of lymph-node metastasis (LNM) in patients with early gastric cancer (EGC),and establish a risk-prediction model based on LNM.Method 962 early gastric cancer patients undergoing curative radical gastrectomy in the First Hospital of Anhui Medical University from July 2011 to April 2016 were enrolled in this study.The relationships between different clinicopathologic characteristics and LNM were analyzed by Chi-square test or Fisher exact probability,and the independent risk factors were determined using Logistic regression analysis.Moreover,LNM risk was stratified and a risk-predicting model was established on the basis of the identified independent risk factors for LNM.Further,the risk-predicting model was validated using 962 EGC cases.The discriminatory accuracy of risk-predicting model was measured by area under ROC curve (ROC-AUC).Results Mucosal differentiated cancer ≤2 cm,irrespective of the existence of an ulcer,had low LNM rates (LNMR ＜ 3.0％).Univariate and multivariate analysis revealed that female EGC patients with submucosal,undifferentiated,vessel invasion and tumor size ＞ 2 cm were independent risk factors of LNM for EGC patients,and relative risks were 1.893,3.173,1.956,1.922 and 9.027 respectively (P ＜ 0.05).ROCAUC of risk-predicting model was 0.768 (P ＜ 0.01),which showed high diagnostic accuracy and sensitivity.Conclusion Female EGC patients with submucosal undifferentiated carcinomas measuring ＞ 2 cm with vessel invasion have higher risk of LNM.
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Objective To investigate the prognostic factors and influencing factors of lymph node ratio (LNR) in patients with Siewert Ⅱ and Ⅲ adenocarcinoma of the esophagogastric junction (AEG).Methods The retrospective case-control study was conducted.The clinicopathological data of 444 patients with Siewert Ⅱ and Ⅲ AEG who were admitted to the First Affiliated Hospital of Anhui Medical University between January 2010 and January 2011 were collected.All the 444 patients underwent radical D2 lymph node dissection,extent of lymph node dissection was inferior mediastinum,around the esophageal hiatus and celiac lymph node.Follow-up usingtelephone interview and outpatient examination was performed to detect patients' prognosis once every 3 months within 2 years postoperatively,once every 6 months from 2 vears to 5 years postoperatively and once every 12 months after 5 years up to October 2016.Observation indicators:(1) follow-up and survival situations;(2) univariate and multivariate factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ[AEG;(3) univariate and multivariate factors analysis affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.The survival curve and rate were respectively drawn and calculated by the Kaplan-Meier method.The univariate analysis and multivariate analysis were respectively done using the Log-rank test and the COX regression model.Results (1) Follow-up and survival situations:all the 444 patients were followed up for 1-81 months,with a median time of 52 months.The 1-,3-,5-year overall survival rates of 444 patients were respectively 93.2％,60.3％ and 45.7％.(2) Factors analysis affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG:results of univariate analysis showed that tumor diameter,tumor differentiation,invasion depth of tumor,pN staging and staging of LNR were related factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG,with statistically significant differences (x2 =12.332,5.898,36.045,38.847,46.464,P＜0.05).Results of multivariate analysis showed that invasion depth of tumor and staging of LNR were independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG [RR =1.393,1.411,95％ confidence interval (CI):1.137-1.708,1.106-1.801,P＜0.05].(3) Factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG:results of univariate analysis showed that tumor diameter,tumor differentiation and invasion depth of tumor were related factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG,with statistically significant differences (x2=20.077,12.618,36.586,P＜0.05).Results of multivariate analysis showed that tumor diameter,tumor differentiation and invasion depth of tumor were independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG (OR=0.684,0.688,0.788,95％ CI:0.485-0.965,0.505-0.936,0.687-0.903,P＜0.05).Conclusions The invasion depth of tunor and staging of LNR are independent factors affecting prognosis of patients with Siewert Ⅱ and Ⅲ AEG.Tumor diameter,tumor differentiation and invasion depth of tumor are independent factors affecting LNR of patients with Siewert Ⅱ and Ⅲ AEG.
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Objective To explore the value of preoperative D-dimer in patients with gastric cancer in judging gastric cancer metastasis and assessing prognosis.Methods Clinicopathological data of 132 patients with gastric cancer in the First Affiliated Hospital of Anhui Medical University between Jan.2010 and Jan.2011 was analyzed retrospectively in this study.All patients were divided into two groups according to the cutoff value (1.465 mg/L)of D-dimer and the relationships between D-dimer and clinicopathological data were determined by chi-square test.Moreover,the association of preoperative D-dimer and the prognosis was analyzed by Kaplan-Meier analysis and Log-rank test.Univariate and multivaritate Cox model were used to analyze the factors which might affect the survival of the patients and significant independent factors.Results A total of 132 patients were enrolled in this study in accordance with the inclusion criteria.D-dimer was positively correlated with the depth of invasion (x2 =4.996,P ＜ 0.05),age (x2 =4.311,P ＜ 0.05) and distant metastasis of gastric cancer (x2 =16.641,P ＜0.01),but not with thc gcndcr,lymph node metastasis,tumor size,the degree of differentiation and TNM stage (P ＞ 0.05).The mean D-dimer level was (1.39 ± 0.7) mg/L in distant metastasis patients and (0.97 ±0.83) mg/L in non distant metastasis patients (P =0.023),the mean plasma D-dimer level in patients alive at the 5 years after the surgery was (0.78 ± 0.58) mg/L,which was significantly lower than the amounts determined for the deceased patients (0.75 ± 0.58) mg/L (P ＜ 0.01).The Kaplan-Meier curves showed that the patients with gastric cancer had a longer time in the low D-dimer group than in the high D-dimer group,showing a significant difference between the two groups (P ＜ 0.01).Univariate analysis showed that the overall survival rate was significantly correlated with the gender,D-dimer,tumor size,the depth of invasion,lymph node metastasis and TNM stage (P all ＜ 0.05).The D-dimer was proved to be independent risk factor for the prognosis of gastric cancer by multivariate analysis(P ＜ 0.05).Conclusion According to the analysis,D-dimer may be valuable biomarker for metastasis patients,besides,D-dimer was an independent prognostic factor for patients with gastric cancer.
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We and others have shown that Astragalus extract [AE] regulates various cellular processes including inflammation and apoptosis. It remains elusive whether and how AE modulates apoptosis in gastric cancer cells in vitro and in vivo. The objective of this study is to determine the effects and mechanisms of AE on the proliferation and apoptosis of human gastric cancer SGC-7901 cells and on tumor growth in orthotopic transplantation gastric tumor model in nude mice. Human gastric adenocarcinoma SGC-7901 cells and nude mice implanted with gastric cancer cells were treated with different concentration of AE and 5-fluorouracil as control. Cellular proliferation, apoptosis and tumor growth as well as interleukin [IL]-6/signal transducer and activator of transcription [Stat] 3 signals pathway were determined. We found that AE inhibited proliferation but caused apoptosis in human gastric cancer cells. Furthermore, the tumor growth and volume were reduced by AE administration in nude mice implanted with gastric cancer cells. In addition, treatments with AE decreased the expression of Bcl-2 proteins, whereas the expression of Bax was increased after AE treatment in tumor tissues of nude mice transplanted with human gastric cancer cells. This was associated with AE-mediated reduction of IL-6, phosphorylated Stat3, survivin and vascular endothelial growth factor. Overall, AE enhances apoptosis in gastric cancer cells in vitro and in vivo, which is associated with decreased activation of IL-6/Stat3 signals
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<p><b>OBJECTIVE</b>To explore the effect of body mass index (BMI) on postoperative short-term prognosis and survival rate of gastric cancer patients.</p><p><b>METHODS</b>Clinical and follow-up date of 153 gastric cancer cases undergoing radical operation in our hospital from January to June 2010 were retrospectively analyzed. According to BMI, patients were divided into low group (BMI<18.5, 23 cases), normal group (18.5≤BMI<25.0, 95 cases) and high group (BMI≥25.0, 35 cases). Clinicopathological features and outcomes were compared the among three groups.</p><p><b>RESULTS</b>Among three groups, the differences in operation time, intraoperative blood loss, number of lymph node retrieved, postoperative hospital stay, lymph node metastasis rate, tumor staging and postoperative complication morbidity were not statistically significant (all P>0.05). Preoperative hemoglobin in the low group was significantly lower as compared to normal and high groups [(106.1±13.8) g/L vs. 113.5±5.2) g/L and (123.5±8.7) g/L, F=3.265, P=0.041], and so was the preoperative albumin [(38.7±2.5) g/L vs. (41.3±0.8) g/L and (43.5±1.4) g/L, F=8.516, P=0.000]. The ratio of gastric cardiac cancer in the low group was significantly lower as compared to the normal and high groups[34.8%(8/23) vs. 68.4%(65/95) and 62.9%(22/35), χ(2)=8.913, P=0.012]. Five-year survival rate of the low, normal and high groups were 43.5%, 50.5% and 65.7% respectively(P=0.189). Subgroup analysis showed that the 5-year survival rate of patients with gastric cardiac cancer in the low group was significantly lower as compared to those in the high group (25.0% vs. 84.6%, P=0.004).</p><p><b>CONCLUSIONS</b>BMI dose not generally play a role in short-term outcomes and long-term survival of the gastric cancer patients. Nutritional improvement and body weight maintenance may be beneficial to low BMI patients, especially those with gastric cardiac cancer.</p>
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Humans , Blood Loss, Surgical , Body Mass Index , Gastrectomy , Length of Stay , Lymph Nodes , Lymphatic Metastasis , Neoplasm Staging , Operative Time , Postoperative Complications , Postoperative Period , Retrospective Studies , Stomach Neoplasms , General Surgery , Survival Rate , Treatment OutcomeABSTRACT
Clinical data of 23 locally recurrent rectal cancer patients underwent radical anterior resection and 69 controls matched by age and gender was retrospectively analyzed to find out the risk factors related to local recur-rence after radical anterior resection of rectal carcinoma. Univariate analysis showed that tumor size, number of positive lymph nodes, distance between tumor and the anal verge and T stage were risk factors for locally recurrent rectal cancer after radical anterior resection. The results of logistic regression analysis showed that T stage ( T4 stage) was an independent risk factor correlated with the tumor recurrence after radical anterior resection and loca-tion of tumor( distance of tumor from the anal verge being less than 5 cm) seemed to be an independent risk factor correlated with the tumor recurrence.
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Despite the gradual improvement in surgical treatment techniques and surgical instruments, the complications and mortality of gastric cancer patients after gastrectomy remain high because of an increased proportion of advanced age and incidence of preoperative morbidity in these patients. Therefore, reducing the peri-operative adverse outcomes in gastrectomy is highly significant. According to published literature, the risk factors of morbidity and mortality may include age, TNM stage, ASA score, POSSUM score, complication, surgeon workload, hospital operation volume, lymphadenectomy scope, combined multiple organ resection, and gastrecto-my type. This review summarizes the recent progress in the risk factors for the mortality and morbidity of gastrectomy.
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Reflux is a common post-gastrectomy complication due to the destruction of physiological antireflux mechanism,which affects patients' post-surgery life quality greatly.It's one of the basic requirements of digestive tract reconstruction to reduce the incidence of post-surgery reflux,and nowadays there are many kinds of anti-reflux surgical methods,which are also hot topics both at home and abroad.The non-surgical anti-reflux treatments are mainly focused on gastrointestinal motility promotion,mucosa protection,acid suppression,and so on.There are still some controversies concerned with which surgical or non-surgical way to choose.It's of great significance to have a deep insight into the associated mechanisms and make a wise decision on the surgical management with proper non-surgical assistance.
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Objective To investigate the risk factors of vagus nerve invasion of advanced adenocarcinoma of esophagogastric junction (AEG).Methods The specimens from 98 patients with advanced AEG who underwent radical total gastrectomy and esophagogastric Roux-en-Y anastomosis from January 2011 to August 2012 at the First Affiliated Hospital of Anhui Medical University were collected.Serial section cutting was done and the upper and bottom incisional edges of every section were marked.The specimens were stained by hematoxylin-eosin solution,S-100 and CK immunohistochemistry.Vagus nerve invasion could be affirmed if cancer cells were observed in the peripheral space of vagus nerve and vagus nerve parenchyma or cancer cells infiltrated along the peripheral space of vagus nerve.Relationship between nerve invasion and clinicopathological factors was analyzed using chi-square test or Fisher exact probability.Factors related to vagus nerve invasion were analyzed using one-way analysis of variance and multi-factor logistic regression analysis.Results The incidence of vagus nerve invasion was 28.6％ (28/98),and the tumor only invaded the vagus nerve which had the same altitude as the upper incisional edge.The results of one-way analysis of variance showed that Siewert classification,intravascular cancer emboli,lymph node metastasis,the degree of lymph node metastasis,clinical staging,the degree of tumor differentiation were correlated with the vagus nerve invasion (x2 =14.156,14.552,5.454,10.706,6.919,14.767,P ＜ 0.05).The results of multi-factor logistic regression analysis showed that Siewert classification,intravascular cancer emboli and degree of tumor differentiation were the independent influencing factors of vague nerve invasion (OR =3.667,10.368,0.249,P ＜ 0.05).Conclusion Vagus nerve invasion is correlated with Siewert classification,intravascular cancer emboli and degree of tumor differentiation.The range of vagus nerve invasion is restricted under the upper incisional edge of tumor section.
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Objective To explore the role of endogenous and exogenous β-glucuronidase( β-G) in the development of primary common duct stones.Method Using modified Fishman method to test the activities of the endogenous and exogenous β -G in 35 patients with primary common duct stones(experimental group) and 11 patients with cystic polypus (control group) respectively.Results The activities of endogenous β -G in the bile of experimental group and control group were (7859.1 ± 738.5 ),(2174.9 ± 348.4 ) U/L(P ＜0.01).While the activities of exogenous β-G in experimental group and control group were (6786.1 ±544.3),(1504.7 ±655.7) U/L (P ＜0.01).In experimental group,there were significant statistical differences in the activities of the exogenous β -G in the sample obtained on the day of operation and 7 days after operation from 13 cases with the acute inflammation [(8935.7 ± 845.9),(2176.1 ± 956.7) U/L]and from 22 cases with the chronic inflammation [(5137.2 ±540.7),(1838.8 ±733.3) U/L],and there were significant higher in the activities of the exogenous β -G in the sample obtained on the day of operation from the acute inflammation compared to those from the chronic inflammation (P ＜ 0.05 ).Conclusions There is obvious correlation between either endogenous or exogenous β -G with primary common duct stones.And the endogenous β -G might be one of the fundamental cause in the development of primary common duct stones.
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Objective To explore the changes of the pressure of sphincter of Oddi(SO)in postoperative patients with cholangiolithiasis.Methods Sixty cases with multiple biliary calculi operation (recurrent cholangiolithiasis group),80 cases with biliary calculi operation at first time(cholangiolithiasis group)and 9 cases with external injuries of pancreas or liver(control group),who were examined in order to identify common bile duct pressure(CBDP),SO basal pressure(SOBP),amplitude of SO contractions (SOCA),frequency of SO contractions(SOF),then comparing the difference of statistics among the three groups.Results CBDP,SOBP,SOCA,SOF in recurrent cholangiolithiasis group and cholangiolithiasis group were significantly higher than those in control group[(13.78 ±9.91),(12.65 ±7.64)mm Hg(1mm Hg =0.133 kPa)vs.(12.54 ± 2.35)mm Hg,(15.27 ± 9.15),(14.89 ± 7.87)mm Hg vs.(13.63 ± 3.27)mm Hg,(106.30 ± 54.70),(98.39 ±38.29)mm Hg vs.(87.65 ±56.38)mm Hg,(6.91 ± 1.92),(6.25 ±2.17)times/min vs.(5.26 ± 2.11)times/min](P ＜ 0.05),but there was no significant difference between recurrent cholangiolithiasis group and cholangiolithiasis group(P ＞ 0.05).Conclusion SO dysfunction resides in the postoperative patients with cholangiolithiasis,and it is possible related with the formation and/or recurrence of cholangiolithiasis.
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Regulatory T cells (Tregs) are a subpopulation of CD4 +T cells highly expressing CD25 and Foxp3. Treg not only involves in autoimmune disease, infection and transplantation tolerance, but also plays a pivotal role in the suppression of anti-tumor immunity during tumor development. Current researches suggest the frequency of Treg is increased in tumor tissues and peripheral blood of patients with HCC, which is associated with HCC development, and affect survival rate and prognosis of HCC patients. Depletion of Treg together with surgical resection of the tumor could be a new approach for HCC, which can enhance tumorspecific T cell memory to remove latent metastasis and protect against recurrence for improvement of HCC therapeutic effect. This review presents the role of Treg in HCC development, the relationship between Treg and prognosis and its clinical practice.
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Objective To explore the relationship between cholelithiasis and the function of sphincter of Oddi (SO). Methods To identify the existence of calculi, choledochoscopy was performed in patients 6 weeks after exploration of the common bile duct (CBD) and T tube drainage, in which 71 were patients with stones in gall bladder, CBD or intra-hepatic bile duct, and 9 with trauma of pancreas or liver.Biliary manometry was performed after choledochoscopy, and an additional manometry was applied after calculus removal if calculi were detected. The indices measured included SO basal pressure ( SOBP), amplitude of SO contractions (SOCA), frequency of SO contractions (SOF) and CBD pressure (CBDP). The patients with cholelithiasis were classified into cholecystolithiasis group, choledocholithiasis group, and hepatolithiasis group according to the position of calculi. Patients with trauma were assigned as the control group.Results All variables in 50 patients with choledocholithiasis were similar before and after the procedure.The variables in patients with cholecystolithiasis and choledocholithiasis had no difference from those of the control (P ＞ 0. 05 ). The SOBP and SOCA of patients in hepatolithiasis group were lower than those of the control group ( P ＜ 0. 05 ), while no difference in SOF was detected (P ＞ 0. 05 ). Conclusion The function of SO in patients with hepatolithiasis is abnormal ( decrease in SOBP and SOCA). Biliary manometry cannot be the reliable evidence for the existence of calculi in bile duct.
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Objective To investigate the changes and significance of the contents of cholecystokinin (CCK) acceptors and nitric oxide synthase (NOS) in sphincter of Oddi and the contents of CCK and nitric oxide (NO) in the blood of the patients with calculus of bile duct. Methods The contents of CCK acceptors and NOS in sphincter of Oddi and the contents of CCK and NO in the blood were determined in 41 patients with gallstone and 6 controls. Results The contents of CCK and NO in the blood of patients with gallstone were significantly higher than that in control [ ( 38.91±4.85 ) pmol/L vs ( 30.67±1.81 ) pmol/L; (40.84±4.74 ) pmol/L vs ( 32.81±1.11) pmol/L] ;The contents of CCK acceptors and NOS in sphincter of Oddi in the patients with gallstone were signifi-cantly lower than in the controls [ (67.59±5.87 ) ng/L vs ( 78.99±1.71 ) ng/L; ( 457.52±45.40 ) ng/L vs ( 519.61±11.38 ) ng/L] ;The contents of CCK and NO in the blood in the different groups with calculus of bile duct were significantly different from those in the controls. Conieusion The degree of the decrease of the contents CCK acceptors and NOS in sphincter of Oddi leads to the decrease of Oddi sphincter function,resuting in cholestasis and promoting the formation of bile duct stone.
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Bile duct stone is the common and frequently-occurring disease, its incidence upwards trend. In recent years, people realize that Oddi sphincter movement disorders play an important role in the inci-dence of bile duct stones. NO, CCK, VIP and theie interactian have effects on sphincter function and dis-charged from the regulation of bile. These factors are necessary to conduct an in-depth study to investigate the cause of bile duct stone and its treatment.
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Purpose:To determine the independent prognostic factors of survival for extrahepatic cholangiocarcinoma after operation. Methods:The clinical data of 52 patients with cholangiocarcinom a treated by operation in our hospital from 1992 to 2002 were retrospectively an alyzed and 10 possible factors influencing survival were selected . A multivaria te analysis was performed in these patients by the computer′s Cox proportional hazard model. Results:The over-all cumulative survival rate was 44.2% in a y ear,23.1% in three years and 9.6% in five years.The univariate analysis showed t he major significant prognostic factors influencing survival of these patients w ere mass of tumor of TNM stage,invasion and metastasis , method of operation , e xpression of E-cd and MMP-9 (P