Risk Factors for Negative Emotions in Patients Undergoing Radical Resection of Hilar Cholangiocarcinoma and Their Influence on Prognosis

Figures & data

Figure 1 Study flowchart.

Table 1 Comparison of Perioperative SAS Score and SDS Score in Patients (Mean ± SD)

Item	N (%)	SAS	t/F	P	SDS	t/F	P
Gender			0.771	0.155		0.697	0.735
Male	121(59.0)	46.23±8.89			47.63±8.96
Female	84(41.0)	47.25±9.88			48.55±9.76
Age (years)			0.293	0.200		−0.335	0.420
<65	128(62.4)	46.80±9.54			47.84±9.01
≥65	77(37.6)	46.40±8.93			48.29±9.78
Family monthly income (yuan)			16.414	0.000		12.730	0.000
<6000	83(40.5)	55.48±7.45			55.73±7.99
≥6000	122(59.5)	40.64±4.26			42.75±5.76
Medical insurance			−14.629	0.000		−12.083	0.000
No	86(42.0)	54.79±8.07			55.28±8.28
Yes	119(58.0)	40.76±4.39			42.75±5.76
Sleep quality			4.359	0.000		3.924	0.105
Worse	122(59.5)	48.80±9.66			50.03±9.30
Good	83(40.5)	43.48±7.76			45.02±8.48
Family care degree			4.219	0.085		6.706	0.023
Lower	49(23.9)	51.35±9.45			55.04±9.71
Higher	156(76.1)	45.17±8.77			45.79±7.98
Operation time			−0.141	0.184		−0.489	0.062
<6h	107(52.2)	46.56±8.85			47.70±8.43
≥6h	98(47.8)	46.74±9.80			48.34±10.17
Bismuth-Corlette type			1.259	0.289		1.340	0.263
I type	75(36.6)	45.52±8.45			46.79±8.08
II type	44(21.4)	48.14±9.24			48.36±8.84
III type	68(33.2)	47.50±9.84			49.59±10.24
IV type	18(8.8)	44.50±10.47			46.22±10.90
Preoperative CA19-9 (U/mL)			−1.449	0.130		−1.428	0.961
<150	108(52.7)	45.76±8.84			47.13±9.25
≥150	97(47.3)	47.64±9.73			48.98±9.27
Preoperative CEA (μg/mL)			−3.798	0.151		−4.476	0.330
<5	103(50.24)	44.27±8.86			45.24±8.86
≥5	102(49.76)	49.05±9.14			50.79±9.03
Tumor diameter (cm)			0.765	0.094		1.371	0.108
<3	113(55.1)	47.10±9.64			48.81±9.81
≥3	92(44.9)	46.10±8.89			47.02±8.55
Differentiation of tumors			67.084	0.000		68.713	0.000
Poorly-differentiated	87(42.4)	52.45±9.56			53.84±9.37
Moderately-differentiated	45(22.0)	47.56±6.00			48.91±6.10
Well-differentiated	73(35.6)	39.18±4.01			40.49±4.29
Lymph node metastasis			−1.478	0.844		−0.926	0.125
No	97(47.32)	45.64±9.28			47.37±9.96
Yes	108(52.68)	47.56±9.26			48.57±8.63
Vascular invasion			−6.238	0.000		−5.852	0.045
No	94(43.41)	42.65±7.84			44.21±8.08
Yes	111(56.59)	50.04±9.12			51.22±9.05

Table 2 Comparison of Liver Function and Inflammatory Indexes Between the Two Groups on the Third Day After Operation (Mean±SD)

Groups	CRP (mg/L)	TNF-α (μg/L)	ALT (U/L)	AST (U/L)	ALP (U/L)
With negative emotions	15.91±4.00	4.36±0.86	53.88±10.49	55.09±15.40	113.45±30.67
Without negative emotions	14.24±3.95	3.77±0.76	51.24±12.00	50.92±15.96	100.78±23.56
t	2.938	5.157	1.065	1.845	3.137
P	0.679	0.000	0.364	0.393	0.008
Groups	γ-GT (U/L)	TBIL (μmol/L)	DBIL (μmol/L)	ALB (g/L)	WBC (×10^9/L)
With negative emotions	153.12±19.67	187.18±35.92	82.09±10.61	44.81±7.83	13.61±4.15
Without negative emotions	136.32±26.94	164.02±41.28	81.83±14.79	45.22±5.90	11.21±3.31
t	5.144	4.106	−0.126	−0.419	4.335
P	0.003	0.000	0.899	0.119	0.012

Abbreviations: CRP, C-reactive protein; TNF-α, tumor necrosis factor-α; ALT, alanine transaminase; AST, aspartate aminotransferase; ALB, Albumin; ALP, alkaline phosphatase; γ-GT, γ-glutamyl transpeptadase; TBIL, total bilirubin; DBIL, direct bilirubin; WBC, White blood cells.

Table 3 Comparison of Postoperative Complications in Patients with or Without Negative Emotions (n, %)

Item	With Negative Emotions (n=79)	Without Negative Emotions (n=126)	χ^2	P
Intra-abdominal hemorrhage
Yes	4(5.06)	6(4.76)	0.01	0.920
No	75(94.94)	120(95.24)
Incision infection
Yes	16(20.25)	13(10.32)	3.947	0.047
No	63(79.75)	113(89.68)
Pleural effusion
Yes	6(7.59)	11(8.73)	0.082	0.775
No	73(92.41)	115(91.27)
Pulmonary infection
Yes	3(3.80)	8(6.35)	0.623	0.430
No	76(96.20)	118(93.65)
Liver failure
Yes	3(3.80)	9(7.14)	0.986	0.321
No	76(96.20)	117(92.86)
Leaky gut
Yes	2(2.53)	5(3.97)	0.304	0.581
No	77(97.47)	121(96.03)
Bile leakage
Yes	14(17.72)	9(7.14)	5.455	0.020
No	65(82.28)	117(92.86)
Postoperative intestinal adhesion
Yes	1(1.27)	4(3.17)	0.743	0.389
No	78(98.73)	122(96.83)

Table 4 Binary Logistic Regression Analysis of Negative Emotional Risk Factors in Patients

Item	B	SE	Wald	P	OR	95% CI
						Lower	Upper
Family monthly income	−2.676	1.125	5.658	0.017	0.069	0.008	0.624
Medical insurance	−2.424	1.220	3.949	0.047	0.089	0.008	0.967
Family care degree	−4.351	1.616	7.245	0.007	0.013	0.001	0.306
Sleep quality	−2.642	1.106	5.706	0.017	0.071	0.008	0.622
Differentiation of tumors	−2.071	1.081	3.669	0.055	0.126	0.015	1.049
Vascular invasion	2.128	1.145	3.454	0.063	8.396	0.890	79.159
TNF-α	1.767	0.768	5.290	0.021	5.851	1.299	26.368
ALP	−0.001	0.022	0.003	0.955	0.999	0.956	1.043
TBIL	−0.002	0.016	0.022	0.883	0.998	0.966	1.030
γ-GT	0.035	0.026	1.810	0.179	1.035	0.984	1.089
WBC	0.138	0.148	0.861	0.353	1.148	0.858	1.534
Incision infection	2.096	1.171	3.204	0.073	8.130	0.820	83.333
Bile leakage	3.381	1.720	3.864	0.049	29.412	1.010	12.871

Abbreviations: TNF-α, tumor necrosis factor-α; ALP, alkaline phosphatase; γ-GT, γ-glutamyl transpeptadase; TBIL, total bilirubin; WBC, White blood cells.

Table 5 Comparison of PS, KPS and QOL Scores Between the Two Groups After Radical Resection of HCCA

Groups	PS	KPS	QOL Score
With negative emotions	2.76±0.82	47.30±10.69	29.57±5.81
Without negative emotions	2.29±0.96	52.83±11.22	32.48±6.03
t	3.696	3.497	3.410
p	0.041	0.000	0.000

Abbreviations: PS, Prognostic Score; KPS, Karnofsky Performance Score; QOL, Quality of Life.

Table 6 Univariate Analysis of Postoperative Survival in HCCA Patients n (%)

	N (%)	1- Year Cumulative Survival Rate (%)	χ^2	P
Gender
Male	121	71.7	0.182	0.669
Female	84	71.2
Age (years)
<65	128	78.3	5.086	0.024
≥65	77	60.9
Preoperative CA19-9 (U/mL)
<150	108	80.2	9.542	0.002
≥150	97	61.8
Preoperative CEA (μg/mL)
<5	103	77.5	3.887	0.049
≥5	102	64.9
Tumor diameter (cm)
<3	113	73.5	0.013	0.909
≥3	92	68.3
Bismuth-Corlette type
I type	75	77.3	1.937	0.586
II type	44	75.0
III type	68	75.0
IV type	18	61.1
Differentiation of tumors
Poorly-differentiated	87	63.2	7.885	0.019
Moderately-differentiated	45	78.4
Well-differentiated	73	76.9
Lymph node metastasis
No	97	82.3	10.656	0.001
Yes	108	61.6
Vascular invasion
No	94	79.0	6.841	0.009
Yes	111	65.1
Combine negative emotions
No	126	78.3	14.238	0.000
Yes	79	61.2
Bile leakage
No	182	75.3	0.741	0.389
Yes	23	69.6
Intra-abdominal hemorrhage
No	195	72.1	0.963	0.326
Yes	10	60.0
Liver failure
No	193	71.8	0.015	0.903
Yes	12	62.5
Leaky gut
No	198	71.9	1.456	0.228
Yes	7	57.1
Pulmonary infection
No	194	72.5	2.640	0.104
Yes	11	53.0

Table 7 Cox Risk Regression Analysis of Factors Related to Postoperative Survival of Patients

Item	B	SE	Wald	P	OR	95% CI
						Lower	Upper
Negative emotion	1.116	0.384	8.445	0.004	3.054	1.438	6.483
Age	0.695	0.281	6.130	0.013	2.003	1.156	3.472
Preoperative CEA	0.188	0.363	0.267	0.605	1.207	0.592	2.459
Preoperative CA19-9	0.712	0.318	5.026	0.025	2.038	1.094	3.798
Differentiation of tumors	0.609	0.553	1.211	0.271	1.839	0.622	5.439
Lymph node metastasis	0.845	0.328	6.642	0.010	2.327	1.224	4.423
Vascular invasion	0.344	0.374	0.850	0.357	1.411	0.678	2.935

Figure 2 Analysis of the Kaplan-Meier survival curve results. (A) Postoperative survival curves of patients with and without negative emotions; (B) Postoperative survival curves between patients < 65 years old and ≥ 65 years old; (C) Postoperative survival curve of patients with preoperative CA19-9 < 150U/mL and preoperative CA19-9 ≥ 150U/mL; (D) Postoperative survival curve of patients with lymph node metastasis and non-lymph node metastasis.