胆囊癌手术治疗及预后相关因素分析

Surgical treatments and prognostic factors of gallbladder cancer

目的探讨胆囊癌手术治疗效果及其预后影响因素。方法回顾性分析2013年1月至2015年1月解放军总医院第一医学中心收治的162例胆囊癌患者临床资料。其中男77例,女85例;平均年龄(61±11)岁。患者均签署知情同意书,符合医学伦理学规定。T1a期9例,T1b期10例,T2期28例,T3期103例,T4期12例。观察患者术中和术后情况,分析影响生存预后的因素。生存分析采用Kaplan-Meier法和Log-rank检验。采用Cox比例风险回归模型分析术后预后的独立影响因素。结果 T1a期9例行单纯性胆囊切除;T1b期以上153例,其中根治性手术81例,姑息性手术45例,腹腔探查术27例。获得术后随访140例,中位生存时间12(9~15)个月;1、3、5年累积生存率分别为51.4%、25.0%、22.1%。T2b期楔形切除与Ⅳb +Ⅴ段切除患者术后5年生存率分别为44.4%、100.0%,差异有统计学意义(χ^(2)=9.00,P<0.05)。T3期清扫6枚以上淋巴结患者根治性切除术后5年生存率为33.3%,明显高于清扫6枚以下淋巴结患者的4.5%(χ^(2)=4.17,P<0.05)。Cox比例风险回归模型分析显示,TNM分期、R0切除是T1b及以上分期胆囊癌患者根治性切除术后生存的独立影响因素(HR=1.08,3.23;P<0.05)。结论肝Ⅳb +Ⅴ段切除可使T2b期胆囊癌患者获益,局部清扫6枚以上淋巴结可使T3期患者获益。TNM分期、R0切除是T1b及以上分期患者根治性切除术后生存的独立影响因素。

Objective To evaluate the surgical efficacy and to explore the prognostic factors of gallbladder cancer.Methods Clinical data of 162 patients with gallbladder cancer admitted to the First Medical Center of Chinese PLA General Hospital from January 2013 to January 2015 were retrospectively analyzed.Among them,77 patients were male and 85 female,aged(61±11)years on average.The informed consents of all patients were obtained and the local ethical committee approval was received.9 cases were classified as stage T1a,10 cases of stage T1b,28 cases of stage T2,103 cases of stage T3 and 12 cases ofstage T4,respectively.Intraoperative and postoperative conditions of all patients were observed.The factors affecting survival and prognosis were analyzed.Survival analysis was performed by Kaplan-Meier method and Log-rank test.The independent prognostic factors were identified by Cox proportional hazards regression model.Results Simple cholecystectomy was performed in 9 cases with stage T1a.Among the 153 cases with stage T1b and above,radical resection was conducted in 81 cases,palliative surgery in 45 cases and abdominal exploration in 27 cases.140 patients were followed up after surgery.The median survival time was 12(9-15)months.The 1-,3-and 5-year cumulative survival rates were 51.4%,25.0%and 22.1%,respectively.The 5-year survival rates of patients with stage T2b undergoing wedge resection and patients receivingsegmentⅣb+Ⅴresection were 44.4%and 100.0%,where significant difference was observed betweentwo groups(χ2=9.00,P<0.05).The 5-year survival rate of patients with stage T3 after radical resection and more than 6 lymph nodes dissection was 33.3%,significantly higher than 4.5%in their counterparts with less than 6 lymph nodes dissection(χ2=4.17,P<0.05).Cox proportional hazards regression model analysis showed that TNM staging and R0 resection were the independent influencing factors for the survival of patients withstage T1b and above gallbladder cancer after radical resection(HR=1.08,3.23;P<0.05).Conclusions SegmentⅣb+Ⅴresection can bring clinical benefits to patients with stage T2b gallbladder cancer.Local dissection of more than 6 lymph nodes can benefit patients with stage T3 gallbladder cancer.TNM staging and R0 resection are the independent prognostic factors of patients with stage T1b and above gallbladder cancer after radical resection.