中国胆囊癌外科治疗现状与病理学特征多中心回顾性研究(附4345例报告)

A largescale multicenter retrospective study of current surgical treatment modalities and pathological characteristics of patients with gallbladder cancer in China:a report of 4,345 cases

目的探讨中国胆囊癌病人的外科治疗模式、病理学特征和预后。方法收集中国13个省市的26家医院自2010年1月至2017年12月收治的4345例胆囊癌病人临床资料,分析中国胆囊癌病人的地区、性别、年龄分布;基于病人的诊疗记录与检查结果对手术病人肿瘤的可切除性进行评估,分析可切除性肿瘤病人的外科治疗模式,参照术前检查、手术记录和术后病理学检查结果评估可切除性肿瘤手术治疗是否达到根治标准,分析行根治性手术胆囊癌病人的病理学特征。结果4345例胆囊癌病人中,男性1664例(38.23%),女性2681例(61.77%)。行外科手术治疗的病人3129例(71.01%),其中可切除性肿瘤2074例(66.28%)。在可切除性肿瘤2074例病人中,仅1133例(54.63%)在术前即诊断为胆囊恶性肿瘤,1002例(48.31%)行根治性切除,1072例(51.69%)未达根治标准。胆囊癌根治性切除病人的病理学检查结果中,736例(73.45%)为腺癌,348例(34.73%)为低分化癌,376例(37.52%)伴肝侵犯,152例(15.17%)伴神经浸润,96例(9.58%)伴血管内癌栓,78例(7.78%)伴周围脂肪组织浸润,89例(8.88%)伴周围器官受累,328例(32.73%)活体组织病理学检查淋巴结阳性。获得生存随访资料的2357例手术治疗病人术后中位生存期为16.17个月,多因素Cox回归生存分析结果显示肿瘤TNM分期(P<0.001)、肿瘤分化程度(P<0.001)、肝脏侵犯(P<0.001)、R0切除(P=0.003)均为术后生存期的独立预后因素。结论中国胆囊癌术前诊断率有待提高;胆囊癌外科治疗模式亟待规范;病理学检查报告中反映的多个因素与胆囊癌病人预后密切相关,其描述的规范化对指导胆囊癌病人的精准治疗有重要意义。

Objective To investigate the current status of surgical treatment,pathological characteristics and prognosis of patients with gallbladder cancer in China.Methods The data of 4,345 patients with gallbladder cancer admitted to 26 hospitals in 13 provinces and cities in China from January 2010 to December 2017 were retrospectively collected.The regional,gender,and age distribution of gallbladder cancer patients in China were summarized and analyzed.Based on medical records and examination results of patients,we evaluated the resectability of tumors in patients treated by surgery,summarized and analyzed the surgical treatment modalities of patients with resectable tumors,and evaluated resectable tumor surgery with reference to the results of preoperative examinations,surgical records and postoperative pathological examinations to estimate whether the treatment meets the standard of radical resection.Results Among the 4,345 patients with gallbladder cancer included in this study,males accounted for 1,664(38.23%)and females accounted for 2,681(61.77%).3,129(71.01%)patients underwent surgical treatment,including 2,074(66.28%)patients with resectable tumors,and only 1,133(54.63%)patients with resectable tumors were diagnosed as gallbladder malignancies before surgery.1,002 cases(48.31%)of resectable tumors underwent radical resection,and 1072(51.69%)cases did not meet the criteria for radical resection.According to the pathological results of patients with radical resection of gallbladder cancer,736 cases(73.45%)were adenocarcinoma,348 cases(34.73%)were poorly differentiated,376 cases(37.52%)had liver invasion,and 152 cases(15.17%)had nerve infiltration,96 cases(9.58%)had intravascular tumor thrombi,78 cases(7.78%)had peripheral fatty tissue infiltration,89 cases(8.88%)had peripheral organ involvement,and 328 cases(32.73%)had positive results of lymph node biopsy.The postoperative median survival time of 2,357 surgically treated patients with survival follow-up data was 16.17 months.The results of multivariate Cox regression survival analysis showed TNM staging(P<0.001),tumor differentiation(P<0.001),liver invasion(P<0.001),R0 resection(P=0.003)are independent prognostic factors for overall survival after surgery.Conclusions The preoperative diagnosis rate of gallbladder cancer in China needs to be improved and the surgical treatment modalities of gallbladder cancer needs to be standardized;multiple factors reported in pathological files are closely related to the prognosis of patients with gallbladder cancer,the standardization of pathological description may be of great significance in guiding the precise treatment of patients with gallbladder cancer.