放化疗在胆囊腺鳞癌治疗中的预后价值

The prognostic value of chemotherapy and radiotherapy in the treatment of adenosquamous carcinoma of gallbladder

目的胆囊腺鳞癌的预后很差,本研究目的是寻找胆囊腺鳞癌预后的影响因素,评价放化疗对胆囊腺鳞癌预后的意义。方法从SEER数据库中分析2004年1月至2015年12月214例胆囊腺鳞癌患者的临床病例资料,采用Kaplan-Meier法分析患者预后的影响因素,采用单因素和多因素Cox分析法探讨胆囊腺鳞癌的独立预后因素。结果胆囊腺鳞癌患者中位生存时间为8个月,1年生存率为34.4%,3年生存率为17.1%。多因素分析结果表明,年龄(HR 1.407,95%CI 1.019~1.944,P=0.038)、M分期(HR 2.219,95%CI 1.595~3.086,P<0.001)、放疗(HR 1.609,95%CI 1.010~2.564,P=0.045)、化疗(HR 1.594,95%CI 1.101~2.307,P=0.013)是胆囊腺鳞癌患者预后的独立因素。42例患者同时接受了化疗和放疗,中位总生存期(OS)为16个月,明显优于未放化疗组(121例,中位OS为5个月)和仅化疗组(49例,中位OS为10个月)。放化疗可提高患者的生存时间(χ^(2)=12.25,P<0.05)。在TNM分期II期和IV期亚组中,同时接受化疗和放疗的胆囊腺鳞癌患者OS比仅接受化疗的患者更长。结论年龄、M分期、放疗、化疗是胆囊腺鳞癌患者的独立预后因素,放疗联合化疗可以有效改善胆囊腺鳞癌患者的预后。

Objective To analyze the prognostic factors and to evaluate the value of chemoradiotherapy for patients with adenosquamous carcinoma of gallbladder.Methods A total of 214 patients with adenosquamous carcinoma of gallbladder retrieved from the Surveillance,Epidemiology,and End Results(SEER)between Jan.2004 and Dec.2015 were analyzed.Kaplan-Meier analysis was used to study the factors on the prognosis for adenosquamous carcinoma of gallbladder.The univariate and multivariate Cox analysis were applied to find independent prognostic factors of adenosquamous carcinoma of gallbladder.Results For patients with adenosquamous carcinoma of gallbladder,the median overall survival time was 8 months,the overall 1-year survival and 3-year survival of patients were 34.4%,17.1%respectively.Multivariate Cox analysis showed that age(HR 1.407,95%CI 1.019-1.944,P=0.038),M classification(HR 2.219,95%CI 1.595-3.086,P<0.001),radiotherapy(HR 1.609,95%CI 1.010-2.564,P=0.045),chemotherapy(HR 1.594,95%CI 1.101-2.307,P=0.013)were independent risk factors on prognosis.The medical overall survival time of patients treated both chemotherapy and radiotherapy(n=42,OS 16 months)was significantly better than that of patients untreated chemoradiotherapy(n=121,OS 5 months)or that of patients treated chemotherapy alone(n=49,OS 10 months).Chemoradiotherapy improved survival time significantly(χ^(2)=12.25,P<0.05).For patients in TNM stage II,IV subgroups,who treated both chemotherapy and radiotherapy had longer OS than those who treated chemotherapy only.Conclusion In this study,age,M classification,radiotherapy and chemotherapy are independent risk factors for patients with adenosquamous carcinoma of gallbladder.Chemoradiotherapy can improve the prognosis of adenosquamous carcinoma of gallbladder,effectively.