T3期胆囊癌手术治疗联合辅助治疗的多中心回顾性研究  

Efficacy analysis of surgical combined with postoperative adjuvant therapy for T3 gallbladder carcinoma: a multicenter retrospective study

作　　者：杨发才 胡晶 苏天杭 耿智敏[3] 张楷 丁俊[5] 雷正清 易滨 李敬东[7] 汤朝晖[8] 程张军[1] 邱应和 Yang Facai;Hu Jing;Su Tianhang;Geng Zhimin;Zhang Kai;Ding Jun;Lei Zhengqing;Yi Bin;Li Jingdong;Tang Zhaohui;Cheng Zhangjun;Qiu Yinghe(Department of General Surgery,Zhongda Hospital Southeast University,Nanjing 210009,China;Department of Medical Imaging,Shidong Hospital,Yangpu District,Shanghai 200433,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi′an Jiaotong University,Xi′an 710000,China;Department of Hepatobiliary and Laparoscopic Surgery,Yixing Hospital,Jiangsu University,Wuxi 214200,China;Department of Pancreaticobiliary Surgery,Shuguang Hospital,Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China;Department of Organ Transplantation,Third Affiliated Hospital of Naval Military Medical University,Shanghai 200438,China;Department of Hepatobiliary Surgery,Affiliated Hospital of North Sichuan Medical College,Hepatobiliary Research Institute of North Sichuan Medical College,Nanchong 617000,China;Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]东南大学附属中大医院肝胆胰外科,南京210009 [2]上海市杨浦区市东医院医学影像科,上海200433 [3]西安交通大学第一附属医院肝胆外科,西安710000 [4]江苏大学附属宜兴医院肝胆、腔镜外科,无锡214200 [5]上海中医药大学附属曙光医院胆胰外科,上海200021 [6]海军军医大学第三附属医院器官移植科,上海200438 [7]川北医学院附属医院肝外一科川北医学院肝胆胰肠疾病研究所,南充617000 [8]上海交通大学医学院附属新华医院普通外科,上海200092

出　　处：《中华外科杂志》2023年第10期863-870,共8页Chinese Journal of Surgery

基　　金：国家自然科学基金(81871988, 82002584);江苏省重点研发计划(BE2019747)。

摘　　要：目的探讨根治性切除后T3期胆囊癌患者行辅助治疗的临床价值。方法回顾性收集2013年1月至2018年12月中国7家医疗机构肝胆中心通过外科治疗的415例T3期胆囊癌患者的临床和病理学资料。男性251例, 女性164例, 年龄(61±11)岁(范围:26~88岁)。根据根治性切除术后是否接受辅助治疗, 将患者分为单纯根治性切除组(A组, n=358)和根治性切除联合术后辅助治疗组(B组, n=57)。采用倾向性评分匹配法对两组患者的一般资料进行1∶1匹配, 卡钳值取0.02。比较匹配前后两组患者临床和病理学特征、总体生存及无病生存情况。采用Cox回归模型进行多因素分析, 并将具有至少一项独立预后因素的患者归类为高危临床病理学亚型, 通过亚组分析探讨具有高危临床病理学亚型患者根治性切除后接受辅助治疗的临床价值。结果匹配后两组患者各有42例, B组胆囊切除术后胆囊癌的发生率和清扫淋巴结数量高于A组(χ^(2)=9.224、2.570, P值均<0.05)。匹配前后两组患者的总体生存率和无病生存率的差异均无统计学意义(P值均>0.05)。单因素和多因素分析结果显示, CA19-9>39 U/ml、神经侵犯、肿瘤位于肝脏侧或双侧、TNM分期为ⅢB~ⅣB期、肿瘤分化程度低是T3期胆囊癌患者总体生存和无病生存的独立不良预后因素(P值均<0.05)。329例(79.3%)患者具有高危临床病理学亚型, 其中根治性切除后接受和未接受辅助治疗患者的中位生存时间分别为17个月和34个月, 3、5年总体生存率分别为40.0%、21.3%和46.0%、46.0%(χ^(2)=4.042, P=0.044);中位无病生存时间分别为9个月和13个月, 3、5年无病生存率分别为23.4%、13.6%和30.2%、18.2%(χ^(2)=0.992, P=0.319)。结论接受根治性手术后再行辅助治疗没有明显提高T3期胆囊癌患者的总体生存和无病生存率, 但可以显著延长具有高危临床病理学亚型的患者的总体生存时间。Objective To explore the clinical value of adjuvant therapy in patients with T3 gallbladder cancer(GBC)who have undergone R0 resection.Methods Clinical and pathological data from 415 patients with T3 GBC who underwent surgical treatment in 7 tertiary centers in China from January 2013 to December 2018 were collected,including 251 males and 164 females,aged(61±11)years(range:26 to 88 years).Depending on whether to receive adjuvant therapy after radical resection,the patients were divided into the radical resection group alone(group A,n=358)and the radical resection combined with the postoperative adjuvant therapy group(group B,n=57).The general data of the two groups were matched 1∶1 by propensity score matching method,and the caliper value was 0.02.Clinicopathological characteristics,overall survival and disease-free survival of the two groups were compared.The Cox regression model was used for multivariate analysis,and patients with at least one or more independent risk factors were classified as high-risk clinicopathological subtypes.Subgroup analysis was performed to assess the clinical value of adjuvant therapy after radical resection in patients with high-risk clinicopathological subtypes.Results After the matching,there were 42 patients in each of the two groups.The incidence of gallbladder cancer and the number of dissected lymph nodes in group B after cholecystectomy were higher than those in group A(χ^(2)=9.224,2.570,both P<0.05).There were no significant differences in overall survival rate and disease-free survival rate between the two groups before and after matching(all P>0.05).The results of the univariate and multivariate analysis showed that CA19-9>39 U/ml,nerve invasion,tumor location(liver side or bilateral),TNM stageⅢB toⅣB,poorly differentiated tumor were independent prognostic factors of overall survival and disease-free survival of patients with T3 stage gallbladder cancer(all P<0.05).Three hundred and twenty-nine patients(79.3%)had high-risk clinicopathological subtypes,and the medi

关 键 词：胆囊肿瘤 外科手术 T3期 根治性切除 辅助治疗 

分 类 号：R735.8[医药卫生—肿瘤]