158例原发性胆囊癌根治性手术临床疗效及预后因素分析

Analysis of therapeutic effect of radical resection and prognostic factor in 158 patients with primary gallbladder cancer

目的探讨经根治性手术治疗的原发性胆囊癌临床疗效及预后影响因素。方法回顾性分析2012年1月至2019年9月苏州大学附属第一医院收治的158例原发性胆囊癌患者的临床及病理资料。应用Kaplan-Meier法绘制生存曲线计算生存率,单因素分析采用Log-rank检验,多因素分析采用Cox比例风险回归模型。结果158例患者中位生存时间30.1(5.0~100.4)个月,术后1、2、3年总累积生存率分别为86.6%、71.1%、60.9%。单因素分析显示:术前总胆红素≥100μmol/L、肿瘤大小>5 cm、胆囊颈部肿瘤、非腺癌、肿瘤低分化、侵犯肝脏、侵犯神经、切缘阳性、浸润深度达T4期、N分期为N2期是影响胆囊癌预后的因素(P<0.05)。多因素分析显示:浸润深度达T4期、N分期为N2期为影响胆囊癌预后的独立危险因素(P<0.05)。结论浸润深度达T4期、N分期为N2期是导致胆囊癌预后不佳的重要因素。晚期胆囊癌术前需充分评估,谨慎手术;扩大淋巴结清扫可增加淋巴结检出数目,提高N分期的准确性,有助于改善预后。

Objective To explore the therapeutic effect of radical resection on primary gallbladder cancer(GBC)and its prognostic factors.Methods The clinical and pathological data of 158 cases with primary GBC admitted to the First Affiliated Hospital of Soochow University from Jan.2012 to Sep.2019 were retrospectively analyzed.The survival curve and cumulative survival rate were respectively drawn and calculated by Kaplan-Meier method.The univariate and multivariate analysis were respectively made with Log-rank test and Cox regression model.Results The median survival time of the 158 patients was 30.1(5.0~100.4)months,and the 1-,2-and 3-year cumulative survival rates were 86.6%,71.1%and 60.9%respectively.The univariate analysis indicated that preoperative level of total bilirubin(≥100μmol/L),tumor size(>5 cm),tumor located in the neck of gallbladder,non-adenocarcinoma,poor differentiation,liver invasion,perineural invasion,positive margin,infiltration depth T4 and N2 staging were significant factors influencing prognosis of patients with primary GBC(P<0.05).The results of multivariate analysis demonstrated that in filtration depth T4 and N2 staging were independent risk factors for prognosis of patients with primary GBC(P<0.05).Conclusion Infiltration depth T4 and N2 staging are important factors for poor prognosis of patients with primary GBC.The advanced gallbladder cancer should be fully evaluated before surgery,and radical resection should be prudently performed.The extended lymph node dissection can increase the examined number of lymph node,enhance the accuracy of diagnosis for N staging,and contribute to improve long-term outcomes.