胆囊癌患者的治疗与预后：单中心76例回顾性分析  

Treatment and prognosis of 76 patients with gallbladder cancer： a single- center retrospective study

作　　者：相小松[1] 李向阳[2] 赵鑫[2] 郑鹏[1] 廖延年 李东虎[1] 嵇武[1] 

机构地区：[1]南京军区南京总医院普通外科,210002 [2]南京大学医学院附属金陵医院

出　　处：《中华肝胆外科杂志》2016年第11期761-765,共5页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的探讨胆囊癌（gallbladder cancer，GBC）患者的有效治疗方法及预后影响因素。方法回顾性分析2005年1月至2015年1月南京军区总医院收治的76例GBC患者的临床及病理资料。采用电话或门诊方式随访至2016年1月。对随访结果进行Cox回归及Kaplan-Meier生存分析。结果69例患者行手术治疗和／或术后周期性化疗，另外7例患者因肝脏或远处器官转移未行手术治疗，仅行周期性化疗。24例患者因肿瘤复发死亡，37例患者因病情进展放弃治疗后死亡，7例患者失访。8例患者仍然存活。Cox分析结果显示肿瘤的浸润深度（HR=2．736）、接受的手术方式（HR=2．207）、辅助化疗方式（HR=0．603）是GBC患者生存时间的影响因素。其中辅助化疗方式是保护因素：未行化疗、单一方式化疗和动静脉联合化疗的平均生存时间分别是（10．64-1．9）、（18．54-2．8）、（26．94-6．4）个月，但其差异无统计学意义（P〉0．05）。结论肿瘤的浸润深度、手术治疗方式，特别是根治性手术是GBC患者生存时间的影响因素。采用吉西他滨＋奥沙利铂动静脉联合化疗有助于延长GBC患者生存时间。Objective To investigate effective treatment modalities and the related factors influencing prognosis of patients with gallbladder cancer. Methods The clinical data of 76 gallbladder carcinoma patients admitted to the Department of General Surgery, PLA Nanjing General Hospital from January 2005 to October 2015 were analyzed retrospectively. Follow-up was carried out via telephone or outpatient service un- til January 2016. Cox regression and Kaplan-Meier models were performed for survival analysis. Results 69 patients were treated with surgery and/or postoperative adjuvant chemotherapy. The remaining 7 patients with liver or distant metastases who did not undergo surgery received chemotherapy. 24 patients died from cancer relapse, 37 patients died from disease progression after giving up treatment, and 7 patients were lost to follow-up. The remaining 8 patients were still alive at the time of follow-up. The depth of cancer invasion （HR =2. 736）, the type surgical procedure （HR =2. 207）, and adjuvant chemotherapy （HR =0. 603） were significant impact factors of survival for GBC patients. Adjuvant chemotherapy was a protective factor. The average survival in the chemotherapy-naive group was （ 10.6 ± 1.9） months, the single chemotherapy group （ 18.5 ± 2.8） months, and the combined chemotherapy group （26.9 ± 6.4） months. There were no significant differences among these groups. Conclusions The depth of cancer invasion, types of surgical procedure particularly radical cholecystectomy, and adjuvant chemotherapy were significant factors of survival in patients with GBC. Radical cholecystectomy combined with arterial and intravenous chemotherapy using gemcitabine and oxaliplatin showed benefits in survival in GBC patients.

关 键 词：胆囊癌 手术治疗 化疗 预后因素 

分 类 号：R735.8[医药卫生—肿瘤]