手术治疗对胆囊小细胞癌患者预后价值的SEER数据库分析  

Analysis of prognostic value of surgical treatment in patients with small cell carcinoma of gallbladder based on SEER database

作　　者：黄坤 何运胜 张红梅 黄正红 袁心柱 赵攀[1] 李建波 赵平武[1] HUANG Kun;HE Yunsheng;ZHANG Hongmei;HUANG Zhenghong;YUAN Xinzhu;ZHAO Pan;LI Jianbo;ZHAO Pingwu(Department of General surgery,Mianyang Traditional Chinese Medicine Hospital,Mianyang,Sichuan 621000,China;Department of Pathology,Mianyang Traditional Chinese Medicine Hospital,Mianyang,Sichuan 621000,China;College of Medical Technology,Chengdu University of Traditional Chinese Medicine,Chengdu 611137,China;Department of Nephropathy,the Affiliated Nanchong Central Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]四川省绵阳市中医医院普通外科,四川绵阳621000 [2]四川省绵阳市中医医院病理科,四川绵阳621000 [3]成都中医药大学医学技术学院,四川成都611137 [4]川北医学院附属南充市中心医院肾内科,四川南充637000

出　　处：《中国普通外科杂志》2022年第8期997-1005,共9页China Journal of General Surgery

基　　金：四川省绵阳市应用技术研究与开发基金资助项目(2019YFZJ004);川北医学院校级基金资助项目(CBY21-QA06)。

摘　　要：背景与目的:胆囊小细胞癌(SCCG)是一种罕见的神经内分泌癌,目前缺少针对该类患者的大样本临床研究证据,手术治疗的预后价值尚不清楚。因此,本研究通过数据库分析评价探讨手术治疗在SCCG中的价值。方法:提取SEER数据库中2000—2018年期间,经病理确诊的SCCG患者的临床资料。根据纳入和排除标准,严格筛选后共纳入116例,依据是否接受手术将患者划分为手术组和非手术组,比较两组间肿瘤特异生存(CSS)和总生存(OS)的差异,并分析患者CSS与OS的影响因素。结果:纳入病例的中位年龄64岁(IQR:54~75岁)。其中男35例(30.17%),女81例(69.83%)。手术组63例(54.31%),非手术组53例(45.69%)。中位随访9个月(IQR:3~19.5个月)。手术组63例中,共死亡45例(71.43%),其中肿瘤相关性死亡42例(66.67%)。非手术组53例中,共死亡48例(90.57%),其中肿瘤相关性死亡44例(83.02%)。估算的手术组与非手术组1年OS分别为62.40%和23.70%;估算的手术组与非手术组1年CSS分别为64.81%和26.08%,两组间差异有统计学意义(χ2=19.75、χ2=8.53,均P<0.001)。多因素Cox回归分析显示:年龄、肝转移情况、放疗、手术是OS的独立影响因素(均P<0.05);肝转移情况、放疗、手术是CSS的独立影响因素(均P<0.05)。手术治疗能提高患者OS(HR=0.54,95%CI=0.33~0.89,P=0.017)和CSS(HR=0.52,95%CI=0.31~0.87,P=0.014)。进一步根据临床病理特征进行分层分析显示,手术治疗提高年龄60岁以下(HR=0.14,95%CI=0.05~0.38,P<0.001)、女性(HR=0.45,95%CI=0.25~0.81,P=0.008)、未婚(HR=0.41,95%CI=0.17~0.94,P=0.037)、无肝转移(HR=0.16,95%CI=0.04~0.67,P=0.012)、未接受放疗(HR=0.56,95%CI=0.32~0.96,P=0.037)、接受过化疗(HR=0.33,95%CI=0.17~0.63,P<0.001)患者的OS。手术治疗提高年龄60岁以下(HR=0.14,95%CI=0.05~0.38,P<0.001)、女性(HR=0.43,95%CI=0.23~0.80,P=0.008)、未婚(HR=0.31,95%CI=0.12~0.79,P=0.013)、无肝转移(HR=0.13,95%CI=0.02~0.69,P=0.017)、未接受放疗(HR=0.51,95%CI=0.29Background and Aims:Small cell carcinoma of the gallbladder(SCCG)is a rare neuroendocrine carcinoma.At present,there is a lack of evidence of clinical research with large sample size for this group of patients,and also the prognostic value of surgical treatment is still unclear.The purpose of this study was to evaluate the prognostic value of surgical treatment in SCCG.Methods:The clinical data of patients with pathologically diagnosed SCCG from 2000 to 2018 were extracted from SEER database.According to the inclusion and exclusion criteria,a total of 116 cases were included after strictly screening.The patients were divided into operation group and non-operation group according to whether they received surgery or not.The differences in cancer-specific survival(CSS)and overall survival(OS)between the two groups were compared,and the influencing factors for CSS and OS were analyzed.Results:The median age of the included patients was 64 years old(IQR:54-75 years),and 30.17%(35/116)of patients were men.There were 63 cases(54.31%)in the operation group and 53 cases(45.69%)in the non-operation group.The median follow-up was 9 months(IQR:3-19.5 months).Of the 63 patients in the operation group,45 died(71.43%),including 42 tumor-related deaths(66.67%).Of the 53 patients in the non-operative group,48 died(90.57%),including 44 tumor-related deaths(83.02%).The estimated 1-year OS of operation group and non-operation group were 62.40%and 23.70%,and the estimated 1-year CSS of operation group and non-operation group were 64.81%and 26.08%,respectively.There were significant differences between the two groups(χ2=19.75 andχ2=8.53,both P<0.001).Results of multivariate prognostic analysis by Cox proportional hazard mode showed that age,presence or absence of hepatic metastasis,receiving surgical treatment or not,and receiving radiotherapy or not were independent influencing factors for OS,and presence or absence of hepatic metastasis,receiving surgical treatment or not,and receiving radiotherapy or not were independent influenc

关 键 词：胆囊肿瘤 癌 小细胞 外科手术 预后 SEER规划 

分 类 号：R735.8[医药卫生—肿瘤]