胆囊癌临床病理特点及预后的多因素分析

Clinicopathological features and multivariate analysis of prognostic factors for patients with gallbladder cancer

目的 探讨胆囊癌的临床病理特点及影响预后的因素.方法 回顾性分析108例胆囊癌患者的临床资料,随访情况.运用Kaplan-Meier法计算生存率,采用Log-rank法比较临床病理特征与预后的关系,采用多因素Cox回归分析筛选影响患者生存的独立危险因素.结果 108例患者随访3～ 102个月,中位随访时间46个月;随访期间77例（71.3％）死亡,31例健在或带瘤生存.患者术后生存时间4～98个月,平均生存时间28.4个月,中位生存时间17个月,1、2、3、5年总生存率分别为54.2％、37.5％、31.3％、21.6％.多因素分析显示：意外胆囊癌、有淋巴结转移、肿瘤分化程度低分化是影响患者预后（生存时间）的独立危险因素.结论 胆囊痛预后较差,临床症状不典型.意外胆囊癌、有淋巴结转移、肿瘤低分化是影响胆囊癌患者预后的独立危险因素.

Objective To explore the clinical pathologic characteristics of gallbladder cancer and prognostic factors for patients with gallbladder cancer.Methods We retrospectively reviewed 108 patients diagnosed pathologically with gallbladder cancer and treated in HuBei Three Gorges Polytechnic Medical College,Yichang Central People＇s Hospital and Yichang First People＇s Hospital from January 2003 to December 2012.Kaplan-Meier method was used to estimate survival.The association between the clinicopathologic characteristic and the prognosis in gallbladder cancer patients was assessed using Log-rank test.Cox proportional hazards model was used to determine independent risk factors.Results All patients were followed up from 3 to 102 months,the median follow-up time was 46 months.There were 77 deaths （71.3％）,31 patients are alive.Survival time after operation was from 4-98 months.The mean and the median survival time were 28.4 months and 17 months respectively.The 1,2,3 and 5-year overall survival rates were 54.2％,37.5％,31.3％ and 21.6％.Multivariate analysis indicated independent risk factors were such as incidental gallbladder cancer,lymph node metastasis,poor differentiation.Conclusions Gallbladder cancer is a malignancy with poor prognosis.Incidental gallbladder cancer,lymph node metastasis,tumor poor differentiation are independent risk factors.