影响胆囊癌病人R0切除术后远期疗效的危险因素及治疗策略分析  

Analysis of prognostic factors and treatment strategies affecting long-term efficacy of R0 resection in patients with gallbladder cancer

作　　者：徐博文 畅建平 魏志成 张搏伦 张笑时 张业繁 李智宇 蔡建强 毕新宇 XU Bo-wen;CHANG Jian-ping;WEI Zhi-cheng(National Cancer Center,National Clinical Research Center for Cancer,Department of Hepatobiliary Surgery,Cancer Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心,国家肿瘤临床医学研究中心,中国医学科学院北京协和医学院肿瘤医院肝胆外科,北京100021

出　　处：《中国实用外科杂志》2023年第11期1258-1266,共9页Chinese Journal of Practical Surgery

基　　金：中国癌症基金会北京希望马拉松专项基金项目(No.LC2022A04)。

摘　　要：目的探讨经R0切除的胆囊癌病人预后影响因素及最佳治疗策略。方法回顾性分析2010年1月至2022年1月期间中国医学科学院北京协和医学院肿瘤医院收治的207例原发性胆囊癌病人的临床及病理学资料。应用Kaplan-Meier法绘制生存曲线计算生存率,采用Cox比例风险回归模型进行单因素及多因素分析,并进一步筛选具有临床指导意义的危险因素采用Log-rank检验进行亚组分析。结果207例病人中位生存时间为42.6(0.3~156.3)个月。术后1、2、3年总累积生存率分别为83.8%、60.1%、57.1%。因素分析结果显示,T3~T4分期、N1~N2分期、M1分期、术后感染是影响胆囊癌总生存期(OS)和无病生存期(DFS)的独立危险因素(P<0.05)。而肿瘤侵犯肝脏是影响病人OS的独立危险因素(P<0.05)。对于T2b期胆囊癌,行解剖性肝Ⅳb+Ⅴ段切除与行楔形切除相比,OS差异无统计学意义(P>0.05)。对于晚期(TNM分期为Ⅲ~Ⅳ期)病人,接受术后辅助化疗的病人有更长的OS(HR=1.708,95%CI 1.043-2.796,P=0.027)和DFS(HR=1.666,95%CI 1.075-2.581,P=0.016)。结论对于胆囊癌病人,根治性手术仍是重要的治疗措施,应准确评估病人TNM分期,分期较差的病人可能预后不佳。同时,谨慎选择手术方式,避免术后感染并发症,以延长病人生存期,减少复发。术后基于化疗的综合治疗可能延长晚期病人生存。Objective To investigate prognostic factors and optimal treatment strategies in patients with gallbladder cancer undergoing curative surgery.Methods A retrospective analysis was performed on clinical and pathological data of 207 patients with primary gallbladder cancer admitted to the Cancer Hospital of the Chinese Academy of Medical Sciences between January 2010 and January 2022.Kaplan-Meier method was used to plot survival curves and calculate survival rates,while Cox proportional hazards regression model was employed for univariate and multivariate analysis.Subsequently,we further screened for clinically relevant risk factors and conducted subgroup analyses using the Logrank test.Results Among the 207 patients,the median overall survival(OS)was 42.6(0.3-156.3)months.The cumulative survival rates at 1-,2-,and 3 years post-surgery were 83.8%,60.1%,and 57.1%respectively.Multivariate analysis results showed that T3-T4 stage,N1-N2 stage,M1 stage,and postoperative infection were independent risk factors affecting overall survival(OS)and disease-free survival(DFS)for patients with gallbladder cancer(P>0.05).For advanced-stage patients(TNM stageⅢ~stageⅣ),those who received postoperative adjuvant chemotherapy had longer OS(HR=1.708,95%CI 1.043-2.796,P=0.027)and DFS(HR=1.666,95%CI 1.075-2.581,P=0.016).Conclusion Radical surgery remains an important treatment approach for patients with gallbladder cancer.It is crucial to accurately assess the TNM stage of the patient,as those with more advanced stages may have a poorer prognosis.Additionally,the cautious selection of surgical approaches to minimize postoperative complications and infections may prolong patient survival and reduce recurrence rates.Postoperative comprehensive treatment based on chemotherapy also may contribute to extended survival in advanced-stage patients.

关 键 词：胆囊癌 根治性手术 总生存期 无病生存期 TNM分期 辅助化疗 

分 类 号：R6[医药卫生—外科学]