胆囊癌根治术中淋巴结清扫范围对T2b期胆囊癌患者预后的影响

Analysis of the impact of lymph node dissection on the prognosis of stage T2b gallbladder cancer

目的:研究胆囊癌根治术中淋巴结清扫范围对T2b期胆囊癌患者预后的影响。方法:回顾性分析2009年6月至2020年5月在上海交通大学医学院附属仁济医院行胆囊癌根治术的47例T2b期胆囊癌患者的临床资料,其中男性17例,女性30例,年龄68(58,72)岁。依据术中淋巴结清扫范围,将患者分为区域淋巴结清扫组(n=28)和扩大淋巴结清扫组(n=19)。比较两组患者的肿瘤糖类抗原199、肝组织切除方式、术后并发症等临床资料。以电话或门诊复查的方式随访患者的生存情况。采用Kaplan-Meier法进行生存分析,生存率比较采用log-rank检验。Cox风险回归模型分析术后生存的影响因素。结果:与区域淋巴结清扫组患者相比,扩大淋巴结清扫组患者的手术时间更长[195(167,220)min比165(152,175)min],淋巴结清扫数量更多[12(9,14)个比8(7,9)个],差异均具有统计学意义(均P<0.05)。区域淋巴结清扫组和扩大淋巴结清扫组患者术后并发症发生率分别为14.3%(4/28)和21.1%(4/19),两组比较,差异无统计学意义(P=0.697)。区域淋巴结清扫组患者术后1、3、5年的累积生存率分别为96.4%、59.4%和52.8%,扩大淋巴结清扫组患者术后1、3、5年的累积生存率分别为84.2%、62.7%和43.0%,两组患者术后累积生存率差异无统计学意义(P=0.643)。多因素Cox风险回归模型分析结果表明,肿瘤糖类抗原199>40 IU/ml(HR=2.98,95%CI:1.24~7.18,P=0.014)、肝脏楔形切除(HR=4.01,95%CI:1.36~11.87,P=0.011)和淋巴结转移阳性(HR=2.99,95%CI:1.22~7.34,P=0.016)是T2b期胆囊癌患者术后生存时间短的危险因素。结论:与区域淋巴结清扫相比,胆囊癌根治术中扩大淋巴结清扫不能延长T2b期胆囊癌患者术后的生存时间。

Objective To evaluate the impact of lymph node dissection in radical surgery on the prognosis for patients with stage T2b gallbladder cancer.Methods Forty-seven patients undergoing radical surgery for T2b gallbladder cancer at Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from June 2009 to May 2020 were retrospectively analyzed,including 17 males and 30 females,aged 68(58,72)years old.According to the extent of lymph node dissection,patients were divided into the regional lymph node dissection group(n=28)and extended lymph node dissection group(n=19).Clinical data including the level of carbohydrate antigen 19-9(CA19-9),fashions of liver parenchymal resection,and postoperative complications were recorded.Survival follow-up was conducted through telephone or outpatient review.Survival analysis was conducted using Kaplan-Meier method and compared using the log-rank test.Cox regression analysis was used to identify the risk factors of overall survival.Results Compared to regional lymph node dissection,the extended lymph node dissection group had a longer operative time[195(167,220)min vs.165(152,175)min]and a greater number of lymph nodes dissected[12(9,14)vs.8(7,9)](both P<0.05).The postoperative complication rates of the two groups were 14.3%(4/28)and 21.1%(4/19),respectively(P=0.697).The cumulative postoperative 1-,3-,and 5-year survival rates were 96.4%,59.4%,and 52.8%in regional lymph node dissection group,and 84.2%,62.7%,and 43.0%in extended lymph node dissection group,respectively,with no significant difference(P=0.643).Multivariate Cox regression analysis indicated that CA19-9>40 IU/ml(HR=2.98,95%CI:1.24-7.18,P=0.014),wedge resection of the liver(HR=4.01,95%CI:1.36-11.87,P=0.011),and positive lymph node(HR=2.99,95%CI:1.22-7.34,P=0.016)were independent risk factors for poor prognosis in patients with stage T2b gallbladder cancer.Conclusion Compared with regional lymphadenectomy,extended lymphadenectomy does not improve the overall survival of patients with stage T2b gallbladder cancer.