中国2010—2017年胆囊癌治疗模式及预后分析  

Analysis of treatment modalities and prognosis of patients with gallbladder cancer in China from 2010 to 2017

作　　者：任泰 李永盛[1] 耿亚军 李茂岚[1] 吴向嵩[1] 吴文广[1] 王许安[1] 束翌俊 包润发[1] 董平[1] 龚伟[1] 顾钧[1] 王雪峰[1] 陆建华[1] 穆嘉盛[1] 潘伟华[2] 张熙 张学利 费哲为[5] 张再洋[6] 王益[7] 曹宏[8] 孙备[9] 崔云甫[10] 朱春富[11] 李兵[12] 郑林辉[13] 钱叶本[14] 刘军[15] 党学义[16] 刘昌[17] 彭淑牖[18] 全志伟[1] 刘颖斌 Ren Tai;Li Yongsheng;Geng Yajun;Li Maolan;Wu Xiangsong;Wu Wenguang;Wang Xu′an;Shu Yijun;Bao Runfa;Dong Ping;Gong Wei;Gu Jun;Wang Xuefeng;Lu Jianhua;Mu Jiasheng;Pan Weihua;Zhang Xi;Zhang Xueli;Fei Zhewei;Zhang Zaiyang;Wang Yi;Cao Hong;Sun Bei;Cui Yunfu;Zhu Chunfu;Li Bing;Zheng Linhui;Qian Yeben;Liu Jun;Dang Xueyi;Liu Chang;Peng Shuyou;Quan Zhiwei;Liu Yingbin(Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Pediatric Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Clinical Research Unit,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of General Surgery,Shanghai Fengxian District Central Hospital,Shanghai 201499,China;Department of General Surgery,Xinhua(Chongming)Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 202150,China;Department of General Surgery,Shaoxing Second Hospital,Shaoxing 312000,Zhejiang Province,China;Department of Gastrointestinal Surgery,the First People′s Hospital of Taicang,Taicang 215400,Jiangsu Province,China;Department of Gastrointestinal Surgery,China-Japan Union Hospital of Jilin University,Changchun 130033,China;Department of Hepato-Pancreato-Biliary Surgery and Key Laboratory of Hepatosplenic Surgery,Ministry of Education,the First Affiliated Hospital of Harbin Medical University,Harbin 150009,China;Department of Pancreatobiliary Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150086,China;Department of Hepato-Pancreato-Biliary Surgery,Changzhou the Second People′s Hospital,Changzhou 213003,China;Department of Hepato-Pancreato-Biliary Surgery,Harbin Medical University Cancer Hospital,Harbin 250081,China;Department of General Surgery,the First Affiliated Hospital of Nanchang University,Nanchang 330019,China;Department of Hepato-Pancreato-Biliary Surgery,the First Affiliated Hospital of Anhui Medical Universit

机构地区：[1]上海交通大学医学院附属新华医院普外科,200092 [2]上海交通大学医学院附属新华医院小儿外科,200092 [3]上海交通大学医学院附属新华医院临床研究中心,200092 [4]上海市奉贤区中心医院普外科,201499 [5]上海交通大学医学院附属新华医院崇明分院普外科,202150 [6]绍兴第二医院普通外科,浙江绍兴312000 [7]太仓市第一人民医院胃肠外科,江苏大仓215400 [8]吉林大学中日联谊医院胃肠外科,长春130033 [9]哈尔滨医科大学附属第一医院肝胆胰外科肝脾外科教育部重点实验室,150009 [10]哈尔滨医科大学附属第二医院胆胰外科,150086 [11]常州市第二人民医院肝胆胰外科,213003 [12]哈尔滨医科大学附属肿瘤医院肝胆胰外科,250081 [13]南昌大学第一附属医院普外科,330019 [14]安徽医科大学第一附属医院肝胆胰外科,合肥230022 [15]山东省立医院肝胆外科,济南250021 [16]山西省肿瘤医院普外科,大原030013 [17]西安交通大学第一附属医院肝胆外科,710061 [18]浙江大学医学院附属第二医院肝胆胰外科,杭州310009 [19]上海交通大学医学院附属仁济医院胆胰外科上海市胆道疾病研究重点实验室癌基因及相关基因国家重点实验室,200127

出　　处：《中华外科杂志》2020年第9期697-706,共10页Chinese Journal of Surgery

基　　金：国家自然科学基金(31620103910、81874181);重大新药创制科技重大专项(2019ZX09301158);上海市人工智能创新发展项目(2019-RGZN-01096);申康新兴前沿项目(SHDC12018107);上海交通大学医学院多中心临床研究项目(DLY201507、15ZH4003)。

摘　　要：目的探讨我国胆囊癌患者的临床特征和预后情况。方法多中心回顾性队列研究。回顾性收集中国10个省市15家医院2010年1月至2017年12月收治的3528例胆囊癌患者资料。男性1345例(38.12%),女性2183例(61.88%);初诊年龄(63.7±10.8)岁(范围:26~99岁)。其中0~Ⅰ期213例(6.04%),Ⅱ~Ⅲ期1059例(30.02%),Ⅳ期1874例(53.12%),382例(10.83%)无法判断分期;行手术治疗2255例(63.92%),行放疗或化疗336例(9.52%,其中172例为姑息性治疗),仅支持治疗1101例(31.21%)。总结和分析3528例胆囊癌患者的地区分布、治疗方式、手术情况、病理学检查结果、合并胆囊结石情况、预后情况。结果在3528例诊断为胆囊癌的患者中,959例(27.18%)来自东部地区,603例(17.09%)来自东北地区,1533例(43.45%)来自中部地区,433例(12.27%)来自西部地区。在1578例可切除的患者中,759例(48.10%)合并胆囊结石。在1578例可切除的患者中,665例(42.14%)行根治性切除,913例手术未达根治标准(57.86%);891例(56.46%)患者在术前得到恶性肿瘤诊断,254例(16.10%)为术中诊断,381例(24.14%)为术后诊断,52例无法判断(3.30%)。在665例根治性切除患者中,切缘阳性69例(10.4%),切缘阴性510例(76.7%),86例(12.9%)切缘情况不详。3528例胆囊癌患者的5年总体生存率为23.0%,其中可切除肿瘤患者的5年生存率为39.6%,晚期未手术患者为5.4%,姑息性手术患者为4.7%。结论我国胆囊癌患者初诊超过半数为Ⅳ期;手术切除是提高可切除患者生存期的有效方式。胆囊癌的治疗尚不规范,亟需有效的综合治疗手段。Objective To evaluate the clinical characteristics and prognosis of gallbladder cancer(GBC)patients in China.Methods This retrospective multicenter cohort study enrolled 3528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces.There were 1345(38.12%)males and 2183(61.88%)females.The age of diagnosis was(63.7±10.8)years old(range:26 to 99 years old).There were 213 patients(6.04%)in stage 0 toⅠ,whereas 1059(30.02%)in stageⅡtoⅢ,1874(53.12%)in stageⅣ,and 382(10.83%)unavailable.Surgery was performed on 2255 patients(63.92%).Three hundred and thirty-six patients received chemotherapy or radiotherapy(9.52%;of which 172 were palliative);1101(31.21%)received only supportive treatment.The patient source,treatment and surgery,pathology,concomitant gallstone,and prognosis were analyzed.Results Among the 3528 GBC patients,959(27.18%)were from East China,603(17.09%)from East-North China,1533(43.45%)from Central China,and 433(12.27%)from West China.Among the 1578 resectable tumor,665(42.14%)underwent radical surgery,913(57.86%)underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one(56.46%)patients were diagnosed before surgery,254(16.10%)during surgery,and 381(24.14%)after surgery(time point of diagnosis couldn′t be determined in 52 patients).Among the 1578 patients with resectable tumor,759(48.10%)had concomitant gallstone.Among the 665 patients underwent radical surgery,69(10.4%)showed positive resection margin,510(76.7%)showed negative resection margin,and 86(12.9%)unreported margin status.The 5-year overall survival rate(5yOS)for the 3528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%,for patients with stageⅣB tumor without surgery was 5.4%,and for patients with stageⅣB tumor underwent palliative surgery was 4.7%.Conclusions More than half GBC patients in China are diagnosed in stageⅣ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further

关 键 词：胆囊肿瘤 疾病特征 手术 预后 

分 类 号：R735.8[医药卫生—肿瘤]