86例手术治疗的胆囊癌肉瘤患者的临床特征及预后因素分析

Clinical characteristics and surgical outcome for 86 cases of carcinosarcoma of gallbladder

目的总结胆囊癌肉瘤的临床特征及分析其预后因素。方法检索Pub Med、Web of Science和万方数据库,并辅以文献追溯、手工检索,收集2014年10月前公开发表的关于胆囊癌肉瘤方面的文献。两名研究人员对纳入研究文献进行分析评价后,提取患者的临床资料,包括性别、年龄、肿瘤大小、临床表现、手术方式、肿瘤分期及生存时间等;总结胆囊癌肉瘤的临床特征,Kaplan-Meier估计生存曲线,Log-rank检验生存率与可能的预后因素之间的关系。结果共有86例(包括本院的1例)患者纳入了研究。其中,男25例,女,61例,男女比例为1∶2.58,平均为64.1±11.5岁,国内病例数为25例,国外为61例。右上腹疼痛为主要的临床表现,有一半以上的病人伴有胆囊结石。Ⅲ、Ⅳ期的患者占多数(AJCC分期)。肿瘤大小平均为7.03±3.67 cm。CSGB病理特征中上皮成分主要腺癌,间叶成分中最常见的是梭形细胞,最少见的是骨样细胞。1、3和5年生存率分别为23.44%、17.85%和11.90%。Log-rank检验生存率在组间的差异,发现肿瘤生存期国内的患者短于国外(χ2=5.23,P=0.0222),Ⅱ期的患者长于Ⅲ期和Ⅳ期(χ2=16.82,P=0.0002),而在不同性别(χ2=0.15,P=0.6991)、年龄<65岁与≥65岁(χ2=1.28,P=0.2582)及肿瘤直径<7 cm与≥7 cm(χ2=0.03,P=0.8530)之间未发现生存差异。结论胆囊癌肉瘤恶性度高,预后差,预后主要与肿瘤分期有关,不同人种肿瘤生存期亦可能不同。

Objective Methods To summarize the clinical characteristics and analyse the prognostic factors of 86 patients with gallblad- The published literature in terms of gallbladder carcinosarcoma before 2014 October was collected by retrieval of PubMed, Web of Science and Wanfang database, also supplemented by literature review and manual retrieval. Two independent researchers analyzed and evaluated the literatures. The clinical data were extracted, including gender, age, tumor size, clinical manifestation, operation mode, tumors stage and survival time. The clinical characteristics of gallbladder carcinosarcoma were analyzed. Kaplan-Meier was used to estimate the survival curve, and Log-rank was used to test the relationship between survival rate and potential prognostic factors. Results We identified 85 qualified cases in published literatures and 1 in our institution. 61 of them were females and 25 males （ F ： M = 2. 58 ： 1 ）. 25 were Chinese patients and the rest were foreigners. The mean age was 64.1 ± 11.5 years （range 33 -90 years）. Abdominal pain in right upper quadrant was the main clinical manifestations, and more than half of them with gallbladder stones. The majority of patients were in stage Ⅲ and Ⅳ according to AJCC stage. The average tumor size was 7.03 ± 3. 67cm. Adenocarcinoma was the main epithelial components of CSGB. The most common mesenchymal component was spindle cells, and the most unusual was the osteoblast like cells. 1,3 and 5 year survival rates were 23.44%, 17.85% and 11.90%, respectively. Log-rank test showed that the survival rate was different in the groups of domestic patients and foreigners （ χ^2 = 5.23, P = 0.0222）, and the patients in stage Ⅱ survived longer than in stage Ⅲ phase and Ⅳ （χ^2 = 16.82, P = 0.0002）, and no survival difference was found between female and male （χ^2=0.15, P =0. 6991 ）, ages less than 65 years old and over 65 （χ^2 = 1.28, P =0.2582） and tumor diameter less than 7cm and more than 7cm （ χ^2 = 0.03, P = 0.8530）. Conclusion Carcinosarcoma of gallbladder has high malignancy and poor prognosis. Tumor stage is an important prognostic factor in of gallbladder, and the survival time of different races may be different.