胆囊癌危险因素的单中心回顾性分析

Single-center retrospective analysis of risk factors for gallbladder cancer

目的:探讨胆囊癌相关的危险因素,为该疾病的防治提供理论依据。方法:采用病例对照研究方法,选取2009年1月—2017年12月就诊于中南大学湘雅医院诊断为胆囊癌的316例患者以及同期就诊的316例年龄组成、性别比例与前者相近的其他疾病患者,分析胆囊癌发病相关危险因素分析。结果:316例胆囊癌患者平均年龄(60.2±10.6)岁,50岁及以上患者占82.28%,男女比例为1:1.95,156例(49.4%)合并胆囊结石,其中胆囊充填型结石30例。单因素及多因素分析显示,胆囊结石是胆囊癌唯一的危险因素(OR=6.72,95%CI=4.52~10.02,P<0.01)。在研究时间范围内胆囊癌合并胆囊结石患者例数呈先上升后下降趋势,每年占胆囊癌患者总例数比例基本一致;女性胆囊癌患者中合并胆囊结石比例较男性高(P<0.01)。胆囊癌合并胆囊结石患者中未行根治性手术以及TNM分期为ⅢB、Ⅳ期的比例均较胆囊癌非胆囊结石患者高(均P<0.05)。结石直径越大或充填型结石的发生胆囊癌的相对危险度增加(均P<0.05)。结论:胆囊结石可能是胆囊癌的主要危险因素之一。随着胆囊结石直径的增大、数目的增多,患胆囊癌的风险也在增加。胆囊癌合并胆囊结石的患者分期相对较晚,对于发展为胆囊癌相对危险度较高的结石类型,建议及时行手术治疗。

Objective： To investigate the risk factors associated with gallbladder cancer, and provide a theoretical basis for the prevention and treatment of this condition. Methods： Using a case-control design, 316 patients admitted and diagnosed as gallbladder cancer from January 2009 to December 2017 in Xiangya Hospital of Central South University and 316 cases admitted for other diseases with similar age distribution and sex ratio to the former during the same period were selected. The risk factors associated with the occurrence of gallbladder cancer was analyzed. Results： Of the 316 patients with gallbladder cancer, the mean age was（60.2±10.6） years, cases over 50 years of age accounted for 82.28%, the male to female ratio was 1：1.95, and 156 cases（49.4%） had concomitant gallstones, of whom 30 cases were gallbladder filling type stones. Univariate and multivariate analysis showed that gallstone was the only risk factor for gallbladder cancer（OR=6.72, 95% CI=4.52–10.02, P0.01）. The number of cases with gallbladder cancer and concomitant gallstones showed a first rising and then declining trend during the studied period, and its proportion accounting for the total number of cases of gallbladder cancer each year did not significantly change; the proportion of cases with concomitant gallstones in female patients was higher than that in male patients（P0.01）. The proportions of gallbladder cancer patients with concomitant gallstones who did not undergo radical surgery and had TNM stage IIIB and IV diseases were higher than those of gallbladder cancer patients without gallstones（both P0.05）. The relative risks to gallbladder cancer were increased in patients with large-diameter gallstones and gallbladder filling type stones（both P0.05）.Conclusion： Gallstones may be one of the major risk factors for gallbladder cancer. The risk for gallbladder cancer is increased with the increase of the diameter and number of the gallstones. The gallbladder cancer patients with concomitant gallstones always have a relatively late stage. Timely surgical treatment is recommended for those with types of stones that are relatively possible to develop gallbladder cancer.