2010—2017年中国胆囊癌诊治流程与预后分析(附7874例报告)  

Diagnosis,treatment and prognosis of gallbladder cancer in China from 2010 to 2017:a report of 7874 cases

作　　者：王一钧 孙旭恒 冯佳毅 任泰 贾子衡 李霖 李雪川 刘珂 刘立果 刘照南 蒲鹏 陶雯琦 颜伟康 央茂 杨明杰 郑志元 邹路 陈涛[1] 陈炜[1] 耿亚军 何敏[1] 李永盛 王辉[1] 吴文广 杨林华[1] 张军峰[1,3] 吴向嵩[2] 顾钧 巴桑 白俊超 蔡鸿宇[7] 曹宏[8] 曹景玉[9] 陈晓亮[10] 崔云甫[11] 戴朝六[12] 党学义[13] 段绍斌[14] 冯健[15] 顾剑峰[16] 韩玮[17] 郝继辉[18] 何松青[19] 张斌 胡小强 姜小清 金慧涵 李兵[24] 李桂臣[25] 李国松[26] 李明章[27] 李其云[28] 李志臻 刘昌军[29] 刘超[30] 刘付宝[31] 刘建生[32] 刘景丰 刘军 刘连新 吕文才 聂高华 杞映华 钱叶本[31] 邵成浩 孙备[39] 王传磊[40] 王槐志 王军华[42] 王雷 王琳 王琦[44] 王益[45] 王志强[46] 武步强[47] 徐军明[48] 徐民[49] 闫军[50] 杨佳华[51] 杨填[52] 喻定刚[53] 袁玉峰[54] 张磊[55] 张启瑜[56] 张彤[57] 张煊[58] 张学利[59] 张学文[60] 赵辉[61] 郑进方[62] 朱春富[63] 朱海宏[64] 左石[65] 耿智敏[66] 龚伟[2] 李茂岚[1,67,68] 张薇[67,68] 刘颖斌[1,3,67,68] WANG Yi-jun;SUN Xu-heng;FENG Jia-yi(Department of Pancreatobiliary Surgery,Renji Hospital Affiliated to Shanghai Jiao Tong University,Shanghai 200127,China;不详)

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]上海交通大学医学院附属仁济医院嘉定分院普外科,上海201800 [4]上海交通大学医学院附属新华医院崇明分院普通外科,上海200092 [5]日喀则市人民医院普外科,西藏日喀则857000 [6]云南省大姚县人民医院普外科,云南大姚675400 [7]南通市肿瘤医院肝胆外科,江苏南通226361 [8]吉林大学中日联谊医院新民院区肝胆外科,吉林长春130499 [9]青岛大学附属医院肝胆胰外科,山东青岛266000 [10]江西省人民医院肝胆外科,江西南昌330006 [11]哈尔滨医科大学附属第二医院胆胰外科,黑龙江哈尔滨150001 [12]中国医科大学附属盛京医院肝胆脾外科,辽宁沈阳110004 [13]山西省肿瘤医院肝胆胰胃外科,山西太原030009 [14]新疆医科大学第四附属医院普外一科,新疆乌鲁木齐830000 [15]天津大学中西医结合医院肝胆外科,天津300110 [16]常熟市第一人民医院普外科,江苏常熟215500 [17]新疆医科大学第一附属医院胰腺外科,新疆乌鲁木齐830054 [18]天津市肿瘤医院胰腺肿瘤科,天津300181 [19]广西医科大学第一附属医院肝胆外科,广西南宁530021 [20]徐州医科大学附属医院普通外科,江苏徐州221006 [21]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,山东济南250021 [22]海军军医大学东方肝胆外科医院胆道一科,上海200438 [23]江南大学附属中心医院肝胆胰外科,江苏无锡214002 [24]哈尔滨医科大学附属肿瘤医院肝胆胰外科,黑龙江哈尔滨150081 [25]中国医科大学附属第一医院胰胆外科,辽宁沈阳110001 [26]保山市第二人民医院普外二科,云南保山678000 [27]包头市中心医院普外科,内蒙古包头014080 [28]江西省肿瘤医院腹部肿瘤外科,江西南昌330029 [29]湖南师范大学附属第一医院(湖南省人民医院)肝胆外科

出　　处：《中国实用外科杂志》2024年第9期1038-1054,1061,共18页Chinese Journal of Practical Surgery

基　　金：国家自然科学基金项目(No.82273016,No.82303937);上海市中央引导地方科技发展专项基金项目(No.YDZX20193100004049)。

摘　　要：目的 回顾总结并探讨2010—2017年间中国人群胆囊癌的诊断、治疗流程与预后情况。方法 收集并整理2010年1月至2017年12月间全国49家医院共计7874例胆囊癌病人的临床诊疗资料。观察指标包括确诊年份、首诊年龄、确诊医院行政区划、确诊医院等级划分、确诊医院年均胆囊癌诊断例数、性别、B超检查情况、CT检查情况、MRI检查情况、肿瘤标记物[癌胚抗原(CEA)、CA19-9、CA125]检查情况、确诊方式、诊断时机、是否接受手术治疗、接受手术是否达根治标准、TNM分期及是否接受辅助治疗等,结局指标包括死亡日期,根本死因,失访日期,失访原因。计量资料通过Kolmogorov-Smirnov test进行正态性检验,符合正态分布的资料以均值±标准差来描述,组间比较采用t检验;不符合正态分布的资料以中位数(第一四分位数,第三四分位数)来描述,组间比较采用U检验。计数资料以频数(占总体百分比)来描述,组间比较采用卡方检验。单因素分析采用Logistics回归分析,多因素分析采用多因素逐步后退Logistics回归分析。总体生存情况采用寿命表法进行计算,生存数据以中位生存期(95%CI)来描述,固定时间点处组间生存率比较采用Z检验,并采用Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行生存分析。结果 胆囊癌确诊病例数随年份持续增长,确诊病人女性多于男性,中位确诊年龄为64(56,71)岁。随时间推移,增强CT、增强MRI、肿瘤标记物CEA、CA19-9、CA125检查比例不断上升,增强CT、增强MRI、磁共振胰胆管造影(MRCP)检出率也在不断提升。首诊年龄、性别、确诊医院行政区划、确诊医院等级划分、确诊医院年均胆囊癌诊断例数、B超检查、平扫及增强CT检查、增强MRI检查、MRCP检查、肿瘤标记物CEA、CA19-9、CA125检查对于胆囊癌早期诊断有着显著作用,其中确诊医院行政区划、确诊医院等级划分、确诊医院To review,summarize,and discuss the diagnosis,treatment,and prognosis of gallbladder cancer in China between 2010 and 2017.Methods Electronic health records of 7874 patients diagnosed with gallbladder cancer from 49 hospitals were collected and structured from January 2010 to December 2017.Observational indicators included the year of diagnosis,age at first diagnosis,the administrative district of the diagnosing hospital,the rank of the diagnosing hospital,the annual number of gallbladder cancer diagnosed at the diagnosing hospital,sex,ultrasound results,CT results,MRI results,CEA levels,CA19-9 levels,CA125 levels,diagnostic criteria,the timing of diagnosis,whether surgical treatment was received,whether the surgery met the radical treatment standard,TNM staging,and whether adjuvant treatment was received.Quantitative data were tested for normal distribution using the Kolmogorov-Smirnov test,described by mean±standard deviation if normally distributed,and compared using the t-test;non-normally distributed data were described by median(first and third quartiles)and compared using the U-test.Categorical data were described by frequency(percentage of total)and compared using the Chi-squared test.Univariate analysis was performed using logistic regression,and multivariate analysis was conducted using stepwise logistic regression.Overall survival rates were calculated using the life table,survival data were described by median survival time(95%confidence interval),comparisons of overall survival rates between groups at certain time points were conducted using the z-test,and survival curves were plotted using the Kaplan-Meier method,with survival analysis performed using the Log-rank test.Results The number of gallbladder cancer cases has continuously increased over time,with more females than males,and the median diagnosis age is 64 years old.The proportion of patients undergoing enhanced CT,enhanced MRI,tumor marker CEA,CA19-9,and CA125 exams has steadily increased,as has the detection rate of enhanced CT,enhanced M

关 键 词：胆囊恶性肿瘤 术前诊断 外科治疗 综合治疗 流行病学 预后 

分 类 号：R6[医药卫生—外科学]