胆囊癌临床分型的合理性及其与预后关系--单中心486例分析

Rationality of clinical classification of gallbladder carcinoma and its relationship with clinical prognosis:a single-center analysis of 486 cases

目的探讨胆囊癌临床分型的合理性及其与预后的关系。方法回顾性分析2011年1月1日至2020年12月31日在西安交通大学第一附属医院行根治性切除术的486例胆囊癌患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男164例,女322例;年龄30~88岁,中位年龄63岁。胆囊癌临床分型:腹腔型234例,肝脏型138例,肝门型49例,混合型65例。临床分型与临床病理学参数的关系分析采用秩和检验和χ2检验;临床分型与预后的关系分析采用Kaplan-Meier法和Log-rank检验。建立胆囊癌树增强朴素贝叶斯(TAN)网络生存预测模型,采用ROC曲线下面积(AUC)评估该模型的预测能力。结果胆囊癌患者的临床分型与患者的年龄、术前TB、CEA、CA19-9、CA125(H=20.45,56.90,24.10,55.62,31.19;P<0.05)以及病理分型、组织学分化、血管侵犯、神经浸润、T分期、N分期(χ2=11.50,15.44,119.69,38.95,255.57,25.34;P<0.05)有关。腹腔型、肝脏型、肝门型、混合型胆囊癌患者的中位生存时间分别为44.7、18.5、17.0、10.0个月,临床分型与预后明显相关(χ2=71.14,P<0.05)。TAN网络生存预测模型显示,胆囊癌临床分型和T分期、周围组织器官侵犯、CA19-9及TB相关。ROC曲线分析显示,该模型对胆囊癌患者术后1、2、3、5年生存预测的AUC分别为0.83、0.78、0.70和0.69,准确度分别为0.76、0.66、0.73和0.84。结论胆囊癌临床分型与患者临床病理特征及预后有关,基于临床分型建立的TAN网络生存预测模型能有效预测预后,本中心数据验证了该临床分型的合理性。

Objective To explore the rationality of clinical classification of gallbladder carcinoma and its relationship with clinical prognosis.Methods Clinical data of 486 patients with gallbladder carcinoma who underwent radical resection in the First Affiliated Hospital of Xi'an Jiaotong University from January 1,2011 to December 31,2020 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,164 patients were male and 322 female,aged from 30 to 88 years,with a median age of 63 years.Clinical classification of gallbladder carcinoma:234 cases were classified as abdominal type,138 as hepatic type,49 as hilar type and 65 as mixed type.The relationship between clinical classification and clinicopathological parameters was analyzed by rank-sum test and Chi-square test.The relationship between clinical classification and prognosis was assessed by Kaplan-Meier method and Log-rank test.The Tree-Augmented Naive(TAN)Bayesian network model was established for the survival prediction of gallbladder carcinoma,and the prediction efficiency of this model was assessed by the area under ROC curve(AUC).Results Clinical classification of gallbladder carcinoma patients was associated with patients'age,preoperative TB,CEA,CA19-9 and CA125 levels(H=20.45,56.90,24.10,55.62,31.19;P<0.05)and the pathological classification,histological differentiation,vascular invasion,nerve infiltration,T stage and N stage(χ2=11.50,15.44,119.69,38.95,255.57,25.34;P<0.05).The median survival of patients with abdominal,hepatic,hilar and mixed type gallbladder carcinoma was 44.7,18.5,17.0 and 10.0 months,respectively.Clinical classification was significantly related with clinical prognosis(χ2=71.14,P<0.05).TAN network survival prediction model showed that clinical classification of gallbladder carcinoma was associated with T stage,invasion of surrounding tissues and organs,CA19-9 and TB levels.ROC curve analysis revealed that the AUC of this model for predicting the 1-,2-,3-,5-year survival of gallbladder carcinoma patients was 0.83,0.78,0.70,0.69,and the accuracy was 0.76,0.66,0.73,0.84,respectively.Conclusions Clinical classification of gallbladder carcinoma is correlated with the clinicopathological features and clinical prognosis of patients.TAN network survival prediction model based on clinical classification can effectively predict the prognosis.The data from our center can validate the rationality of this clinical classification.