中国胆囊癌流行病学特征与诊治及预后分析(附6 159例报告)  

Epidemiological characteristics,diagnosis,treatment and prognosis of gallbladder cancer in China:a report of 6159 cases

作　　者：孙旭恒 王一钧 张薇[1] 耿亚军 李永盛 任泰 李茂岚[2] 王许安 吴向嵩[2] 吴文广 陈炜[1] 陈涛[1] 何敏[1] 王辉[1] 杨林华[1] 邹路 蒲鹏 杨明杰 刘照南 陶雯琦 冯佳毅 贾子衡 郑志元 钟丽静 钱源滢 董平[2] 王雪峰[2] 顾钧[2] 刘连新 钱叶本[4] 顾剑峰[5] 柳咏 崔云甫[7] 孙备[8] 李兵[9] 邵成浩 姜小清 马强 郑进方[12] 刘昌军[13] 曹宏[14] 陈晓亮[15] 李其云[16] 王琳 王昆华[18] 张磊[19] 郑林辉[20] 朱春富 蔡鸿宇[22] 曹景玉[23] 朱海宏[24] 刘军 党学义[26] 刘建生[27] 张学利[28] 徐军明[29] 费哲为 杨晓平 杨佳华[32] 张再洋[33] 王旭林[34] 王益[35] 郝继辉[36] 张启瑜[37] 金慧涵[38] 刘昌[39] 韩玮[40] 闫军[41] 武步强[42] 戴朝六[43] 吕文才[44] 全志伟[2] 彭淑牖[45] 龚伟[2] 刘颖斌[1] Sun Xuheng;Wang Yijun;Zhang Wei;Geng Yajun;Li Yongsheng;Ren Tai;Li Maolan;Wang Xu'an;Wu Xiangsong;Wu Wenguang;Chen Wei;Chen Tao;He Min;Wang Hui;Yang Linhua;Zou Lu;Pu Peng;Yang Mingjie;Liu Zhaonan;Tao Wenqi;Feng Jiayi;Jia Ziheng;Zheng Zhiyuan;Zhong Lijing;Qian Yuanying;Dong Ping;Wang Xuefeng;Gu Jun;Liu Lianxin;Qian Yeben;Gu Jianfeng;Liu Yong;Cui Yunfu;Sun Bei;Li Bing;Shao Chenghao;Jiang Xiaoqing;Ma Qiang;Zheng Jinfang;Liu Changjun;Cao Hong;Chen Xiaoliang;Li Qiyun;Wang Lin;Wang Kunhua;Zhang Lei;Zheng Linhui;Zhu Chunfu;Cai Hongyu;Cao Jingyu;Zhu Haihong;Liu Jun;Dang Xueyi;Liu Jiansheng;Zhang Xueli;Xu Junming;Fei Zhewei;Yang Xiaoping;Yang Jiahua;Zhang Zaiyang;Wang Xulin;Wang Yi;Hao Jihui;Zhang Qiyu;Jin Huihan;Liu Chang;Han Wei;Yan Jun;Wu Buqiang;Dai Chaoliu;Lyu Wencai;Quan Zhiwei;Peng Shuyou;Gong Wei;Liu Yingbin(Department of Pancreatobiliary Surgery,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai Cancer Institute,State Key Laboratory for Oncogenes and Related Genes,Shanghai Key Laboratory of Biliary Tract Disease Research,Shanghai 200127,China;Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Univer-sity of Science and Technology of China,Anhui Provincial Hospital,Hefei 230001,China;Department of Hepato-Biliary-Pancreatic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of General Surgery,Changshu No.1 People's Hospital,Changshu 215500,Jiangsu Province,China;Department of Oncology,Changzhou Hospital of Traditional Chinese Medicine,Changzhou 213003,Jiangsu Province,China;Department of Pancreatobiliary Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Hepato-Biliary-Pancreatic Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Hepato-Biliary-Pancreatic Surgery,Harbin Medical University Can

机构地区：[1]上海交通大学医学院附属仁济医院胆胰外科,上海市肿瘤研究所,癌基因及相关基因国家重点实验室,上海市胆道疾病研究重点实验室,上海200127 [2]上海交通大学医学院附属新华医院普通外科,上海200092 [3]中国科学技术大学附属第一医院(安徽省立医院)肝胆外科,合肥230001 [4]安徽医科大学第一附属医院肝胆胰外科,合肥230022 [5]常熟市第一人民医院普外科,常熟215500 [6]常州市中医医院肿瘤科,常州213003 [7]哈尔滨医科大学附属第二医院胆胰外科,哈尔滨150001 [8]哈尔滨医科大学附属第一医院肝胆胰腺外科,哈尔滨150001 [9]哈尔滨医科大学附属肿瘤医院肝胆胰外科,哈尔滨150081 [10]海军军医大学第二附属医院(上海长征医院)普通外科四科,上海200003 [11]海军军医大学东方肝胆外科医院胆道一科,上海200438 [12]海南省人民医院肝脏外科,海口570311 [13]湖南师范大学附属第一医院(湖南省人民医院)肝胆外科,长沙410000 [14]吉林大学中日联谊医院新民院区肝胆外科,长春130499 [15]江西省人民医院肝胆外科,南昌330006 [16]江西省肿瘤医院腹部肿瘤外科,南昌330029 [17]空军军医大学西京医院肝胆胰脾外科,西安710032 [18]昆明医科大学第一附属医院胃肠外科,昆明650032 [19]兰州大学第一医院普通外科五科,兰州730020 [20]南昌大学第一附属医院急诊科,南昌330006 [21]南京医科大学附属常州第二人民医院肝胆胰外科,常州213004 [22]南通市肿瘤医院肝胆外科,南通226361 [23]青岛大学附属医院肝胆胰外科,青岛266000 [24]青海省人民医院普通外科,西宁810007 [25]山东第一医科大学附属省立医院(山东省立医院)器官移植肝胆外二科,济南250021 [26]山西省肿瘤医院普通外科一病区,太原030009 [27]山西医科大学第一医院普通外科,太原030001 [28]上海交通大学附属第六人民医院南院,上海市奉贤区中心医院普通外科,上海201

出　　处：《中华消化外科杂志》2022年第1期114-128,共15页Chinese Journal of Digestive Surgery

基　　金：国家自然科学基金(3213000192,81874181,2019XH004);上海市科委项目(YDZX20193100004049,20JC1419101);重大新药创制科技重大专项(2019ZX09301-158);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2010—2017年中国胆囊癌临床流行病学特征、诊断、治疗与预后情况。方法采用单病种回顾性登记队列研究方法。基于“真实世界研究”理念,收集2010年1月至2017年12月中国胆囊癌研究小组(CRGGC)建立的中国胆囊癌多中心回顾性临床资料数据库中42家医院收治的6159例胆囊癌患者的临床病理资料。观察指标:(1)病例来源情况。(2)年龄与性别分布情况。(3)诊断情况。(4)外科治疗与预后情况。(5)综合治疗与预后情况。随访数据由CRGGC对各协作中心的临床随访数据进行收集整理,主要结局指标为手术治疗患者手术之日或未手术患者确诊之日起,至结局事件发生或随访截至时间的总体生存时间。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(Q1,Q3)或M(范围)表示,组间比较采用U检验。计数资料以绝对数和(或)百分比表示,组间比较采用χ^(2)检验。单因素分析采用强迫引入Logistic回归模型,将P<0.1的因素引入多因素分析。多因素分析采用逐步后退Logistic回归模型。采用寿命表法计算生存率,采用Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行生存分析。结果(1)病例来源情况:42家医院中,三级甲等医院35家,三级乙等医院7家;胆囊癌收治高流量医院16家,非高流量医院26家。42家医院地域分布:中部地区9家,东北地区5家,东部地区22家,西部地区6家。6159例患者地域分布:2154例(34.973%)来自中部地区,705例(11.447%)来自东北地区,1969例(31.969%)来自东部地区,1331例(21.611%)来自西部地区。6159例患者总体院均诊断与治疗数为(18.3±4.5)例/年;其中4974例(80.760%)来源于高流量医院,院均诊断与治疗患者数为(38.8±8.9)例/年;1185例(19.240%)来源于非高流量医院,院均诊断与治疗患者数为(5.7±1.9)例/年。(2)年龄与性别分布情况:6159例患者确诊年龄为64(56,71)岁;其中男性2247例(36.483Objective To investigate the epidemiological characteristics,diagnosis,treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods The single disease retrospective registration cohort study was conducted.Based on the concept of the real world study,the clinicopathological data,from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer(CRGGC),of 6159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected.Observation indicators:(1)case resources;(2)age and sex distribution;(3)diagnosis;(4)surgical treatment and prognosis;(5)multimodality therapy and prognosis.The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC.The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up.Measurement data with normal distribu-tion were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(Q1,Q3)or M(range),and com-parison between groups was conducted using the U test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.Univariate analysis was performed using the Logistic forced regression model,and variables with P<0.1 in the univariate analysis were included for multivariate analysis.Multivariate analysis was performed using the Logistic stepwise regression model.The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves.Log-rank test was used for survival analysis.Results(1)Case resources:of the 42 hospitals,there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals,16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder ca

关 键 词：胆道肿瘤 术前诊断 外科治疗 辅助治疗 流行病学 影响因素 预后 

分 类 号：R735.8[医药卫生—肿瘤]