119例进展期胆囊癌临床治疗的疗效分析

Efficacy of Clinical Treatment in 119 Cases of Advanced Gallbladder Carcinoma

目的:分析能够影响进展期胆囊癌(gallbladder cancer,GBC)患者预后的因素,探讨不同治疗方法对患者预后的影响。方法:收集2003年1月至2012年12月我院收治的119例进展期GBC患者的临床资料和随访资料,通过单因素分析和多因素分析探讨预后相关因素,并进行生存分析。结果:单因素分析提示,CEA、CA199、术前胆红素水平、有无黄疸、肿瘤分化程度、治疗方式、切缘、TNM分期及淋巴结转移均为影响患者预后的危险因素。多因素分析提示,TNM分期为ⅢA~ⅣA期、淋巴结转移、低分化或未分化、治疗方式和是否实现根治性R0切除是影响进展期GBC患者预后的危险因素。ⅢA和ⅢB期患者接受的治疗方法有GBC标准根治术、扩大根治术、术后化疗、姑息治疗和支持治疗,接受不同治疗的ⅢA期患者的中位生存时间分别为10.3个月、14.0个月、27.8个月、9.0个月和5.7个月,ⅢB期患者则为12.0个月、22.0个月、23.9个月、7.9个月和3.1个月,差异有统计学意义(P<0.05)。接受根治性治疗的患者中,R0切除率为85.3%,1年、3年和5年生存率分别为72.3%、33.6%和20.0%,均优于接受非根治性R1/2切除组的患者(21.8%、0%和0%),且中位生存时间也明显延长(29.9个月vs 10.3个月),差异有统计学意义(χ2=15.012,P<0.05)。结论:影响进展期GBC患者预后的因素有低分化或未分化、治疗方式不同、原发肿瘤能否根治性R0切除、TNM为ⅢA~ⅣA期以及淋巴结转移。根治性R0切除组患者的预后明显优于非根治性切除组。对于ⅢA~ⅣA期的患者,在患者身体条件允许的前提下,可通过GBC扩大根治术提高根治性切除率,术后再适当予以辅助化疗,可在一定程度上改善患者的术后生存期。

Objective:To analyze prognostic factors affecting patients with advanced gallbladder carcinoma(GBC),and investigate the effect of different treatment methods on the prognosis of patients.Methods:Retrospective analysis was performed on clinical data of 119 GBC patients admitted in our hospital from January 2003 to December 2012.Univariate and multivariate analyses were conducted to analyze factors affecting the prognosis of patients,and survival analyses were carried out.Results:Results of univariate analysis revealed that carcinoembryonic antigen,carbohydrate antigen 19-9,preoperative bilirubin level,jaundice,tumor differentiation,surgical method,margin,the TNM classification and lymph node metastasis were risk factors affecting the prognosis of patients.Multivariate analysis showed that stageⅢA-ⅣA(the TNMclassification),lymph node metastasis,poorly-differentiated or undifferentiated tumor,therapeutic method,and R0 resection were risk factors for prognosis in patients with advanced GBC.The median survival time of stageⅢA andⅢB GBC patients who received radical resection,extended radical resection,postoperative chemotherapy,alleviative treatment and conservative treatment were 10.3 vs 12.0,14.0 vs 22.0,27.8 vs 23.9,9.0 vs 7.9,and 5.7 vs 3.1 months,respectively(P<0.05).In patients with radical resection,the incidence of R0 resection was 85.3%,and the 1-year,3-year and 5-year survival rate after radical resection were 72.3%,33.6%and 20.0%which were remarkably higher than those of patients with Rl/2 resection(21.8%,0%and 0%)(χ2=15.012,P<0.05).And there was also statistically significant difference in the median survival time of patients with R0 vs Rl/2 resection(29.9 vs 10.3 months,χ2=15.012,P<0.05).Conclusion:Poorly-differentiated or undifferentiated tumor,therapeutic method,R0 resection,stageⅢA-ⅣA,lymph node metastasis are factors affecting the prognosis of patients.The prognosis of patients with R0 resection is significantly better than that of patients with Rl/2 resection.If stageⅢA-ⅣA patients are in good condition,the rate of R0 resection can be improved by extended radical resection and postoperative adjuvant chemotherapy,which can improve the survival time of patients.