肿瘤分期对胆囊癌术式选择及预后判断临床意义研究

Study of gallbladder cancer staging systems for surgery treatment choice and prognosis estimation

目的了解各种胆囊癌分期方法的应用现状,探讨不同分期方法对胆囊癌术式选择及预后判断的指导作用。方法利用检索工具[中文使用中国知网(CNKI),英文使用Pubmed,主题词为胆囊癌和分期、gallbladder cancer and stage],对2001年1月至2010年6月全球以中文和英文公开发表的文献进行检索并分析。结果胆囊癌分期方法主要有Nevin分期、日本胆道外科协会(JSBS)分期及美国癌症联合委员会(AJCC)/国际抗癌联盟(UICC)的TNM分期。CNKI的235篇文献中使用Nevin分期为163篇(69.4%),JSBS分期为4篇(1.7%),TNM分期65篇(占27.6%),其他为3篇(1.3%)。Pubmed检索符合要求353篇,Nevin分期71篇(20.1%),JSBS分期14篇(4%),TNM分期261篇(73.9%),其他改良或自创的分期7篇(2%)。结论 Nevin分期早期应用较广,便于记忆,但指导术式选择及预后判断的准确性及科学性欠佳;JSBS分期及淋巴结分组繁琐,临床使用不够方便;TNM分期详尽、易记,淋巴结分站合理,与预后密切相关,目前临床应用广泛并呈明显上升趋势。

To realize the application of gallbladder cancer staging systems and estimate their value of guiding the surgery treatment choice and prognosis estimation. Methods Correlative literatures were retrieved with the key words “gallbladder cancer and stage” using CNKI （Chinese） and Pubmed （English） from January 2001 to June 2010, and were tabulated and critically appraised. Results There were three main kinds of methods for gallbladder cancer staging, Nevin, JSBS and TNM （AJCC/UICC）. Among 235 papers retrieved with CNKI, there were 163 （69.4%） papers of Nevin stage, 4（1.7%） papers of JSBS, 65（27.6%） papers of TNM and 3（1.3%） papers of others. Among 353 papers retrieved with Pubmed, there were 71（20.1%） papers of Nevin stage, 14（4%） papers of JSBS stage, 261（73.9%） papers of TNM stage and 7（2%） papers of others. Conclusion Early application of Nevin stage is popular and easily remembered bat the value of guiding the surgery treatment choice and prognosis estimation is poor. JSBS stage and lymph node grouping were complicated for clinical application. TNM stage is particular and easily applied with reasonable lymph node grouping. The value for guiding surgery treatment choice and prognosis estimation is more rational than the others. The application of TNM stage is becoming more and more popular.