胆囊癌的临床病理特点及淋巴转移的临床病理危险因素分析

Analysis of clinicopathologic characteristics of gallbladder cancer and clinicopathologic risk factors for lymphatic metastasis

目的:探讨胆囊癌的临床病理特点及淋巴转移的临床病理危险因素。方法:回顾性分析2013年3月-2018年3月收治的50例胆囊癌患者的临床资料,对其临床病理特点进行总结,对患者淋巴转移的临床病理因素进行单因素和多因素分析。结果:50例患者中,女性比例高于男性(男女比例为2:3);7例患者无任何症状,43例有不同程度的上腹痛、恶心呕吐、乏力、体质量或食欲下降等;肿瘤部位以胆囊体底部居多(58.0%),T分期以T3~T4为主(78.0%),多数组织学分级恶性度较高(G3~G4者占64.0%),有淋巴转移者32例(64.0%)。单因素分析显示,肿瘤部位、T分期、组织学分级、远处转移、血管浸润、肝脏侵犯和血清CEA水平与患者淋巴结转移明显有关(均P<0.05)。Logistic多元回归模型分析结果显示,肿瘤部位、T分期、组织学分级、远处转移为胆囊癌患者淋巴转移的独立危险因素(均P<0.05)。结论:胆囊癌患者中女性较多,淋巴转移常见。多种因素与患者淋巴转移密切相关。临床针对这些患者在术中应仔细清扫淋巴组织,避免局部复发及远处转移,以期延长患者生存时间。

Objective: To investigate the clinicopathologic characteristics of gallbladder cancer and the clinicopathologic risk factors for lymphatic metastasis.Methods: The clinical data of 50 patients with gallbladder cancer treated from March 2013 to March 2018 were retrospectively analyzed. The clinicopathologic characteristics of the patients were summarized. The clinical and pathological factors for lymphatic metastasis of the patients were determined by univariate and multivariate analysis.Results: Among the 50 patients, the proportion of females was higher than that of males(male to female ratio was 2:3);7 cases had no symptoms, 43 cases presented with different degrees of upper abdominal pain, nausea/vomiting, tiredness, weight loss and anorexia, and 32 cases(64.0%) had lymphatic metastasis. Results of univariate analysis showed that tumor location, T stage, histological grade, distant metastasis, vascular invasion,hepatic invasion and serum CEA level were significantly associated with lymph node metastasis of the patients(all P<0.05). Results of Logistic multivariate regression analysis showed that tumor location, T stage, histological grade and distant metastasis were independent risk factors for lymphatic metastasis of gallbladder cancer patients(all P<0.05).Conclusion: Women account for a relatively high proportion of the patients with gallbladder cancer, and lymph node metastasis is common. Many factors are closely associated with lymph node metastasis of the patients. In these patients, the lymphatic tissue should be carefully cleared during operation to avoid local recurrence and distant metastasis, and thereby prolong their survival time.