45例胆囊鳞癌和腺鳞癌临床病理特征及生存分析  

Clinicopathological characteristics and survival analysis of 45 patients squamous cell carcinoma and adenosquamous cell carcinoma of the gallbladder

作　　者：余旭旭 魏杰 楼芳[2] YU Xuxu;WEI Jie;LOU Fang(Department of Medical Oncology,Shaoxing Campus,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Shaoxing 312000,China;Department of Medical Oncology,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China;Department of Medical Insurance and Expenses,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院绍兴院区肿瘤内科,浙江绍兴312000 [2]浙江大学医学院附属邵逸夫医院肿瘤内科,浙江杭州310000 [3]浙江大学医学院附属邵逸夫医院医保医费办公室,浙江杭州310000

出　　处：《肿瘤基础与临床》2024年第6期621-626,共6页journal of basic and clinical oncology

基　　金：希思科-信达肿瘤免疫治疗研究基金:资助项目(Y-XD2019-225);希思科-百时美施贵宝肿瘤免疫研究基金:资助项目(Y-BMS2019-098)。

摘　　要：目的 分析胆囊鳞癌和腺鳞癌的临床病理特征及预后。方法 回顾性分析2019年1月至2023年12月浙江大学医学院附属邵逸夫医院收治的45例胆囊鳞癌和腺鳞癌患者的临床资料。采用Kaplan-Meier法绘制生存曲线,Log-rank检验比较组间差异,应用COX回归模型分析预后影响因素。结果 45例患者中胆囊鳞癌7例、胆囊腺鳞癌38例,24例(53.33%)患者首诊时有右上腹部疼痛症状。彩超提示12例(26.67%)有胆囊壁增厚和胆管扩张,26例(57.78%)患者可见胆囊结石。肿瘤标志物检查有20例(44.44%)癌胚抗原升高,21例(46.67%)糖链抗原19-9升高,23例(51.11%)糖链抗原125升高。美国癌症联合委员会分期多为Ⅲ期(23例,51.11%)和Ⅳ期(14例,31.11%),25例(55.56%)伴肝脏浸润,15例(33.33%)伴神经浸润。本研究中35例(77.78%)患者接受手术治疗,其中15例行单纯胆囊切除术、12例行根治性胆囊切除术、8例行扩大胆囊切除术,经手术治疗和未经手术治疗的胆囊鳞癌和腺鳞癌患者中位总生存时间分别为15.57、7.85个月(χ^(2)=5.691,P=0.017)。男性(HR=2.596,95%CI:1.055~6.386,P=0.038)、既往有吸烟史(HR=6.983,95%CI:2.367~20.604,P<0.001)、饮酒史(HR=4.011,95%CI:1.339~11.971,P=0.013)、伴有肝脏浸润(HR=4.607,95%CI:1.758~12.077,P=0.002)、N_2分期(HR=6.097,95%CI:1.752~21.221,P=0.004)是影响预后的危险因素;接受手术治疗(HR=0.310,95%CI:0.114~0.841,P=0.021)、确诊时TNM分期早(Ⅰ期HR=0.275,95%CI:0.028~2.725,P=0.027;Ⅱ期HR=0.207,95%CI:0.043~0.989,P=0.048;Ⅲ期HR=0.270,95%CI:0.095~0.768,P=0.014)是预后的保护因素。结论 胆囊鳞癌和腺鳞癌侵袭性强,应尽早明确诊断,性别、N分期、既往吸烟饮酒的生活史、淋巴结侵犯、外科手术切除是胆囊鳞癌和腺鳞癌患者生存的重要影响因素。Objective To analyze the clinicopathological characteristics and survival prognosis of gallbladder squamous cell carcinoma and adenosquamous cell carcinoma.Methods This study conducts a retrospective analysis of clinical data from 45 patients diagnosed with gallbladder squamous cell carcinoma and adenosquamous carcinoma at the Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,from January 2019 to December 2023.Kaplan-Meier survival analysis was conducted along with Log-rank tests to compare group differences,and COX regression was utilized to analyze prognostic factors.Results Among 45 patients,there were 7 cases of gallbladder squamous carcinoma and 38 cases of gallbladder adenocarcinoma.Of these,24 patients(53.33%)were presented with right upper quadrant pain at diagnosis.Ultrasound indicated that 12 patients(26.67%)showing gallbladder wall thickening and bile duct dilation,26 patients(57.78%)had gallstones.Tumor marker tests revealed elevated carcinoembryonic antigen in 20 patients(44.44%),elevated carbohydrate antigen 19-9 in 21 patients(46.67%),and elevated carbohydrate antigen 125 in 23 patients(51.11%).AJCC staging was predominantly stageⅢ(23,51.11%)and stageⅣ(14,31.11%),with 25 patients(55.56%)exhibiting liver infiltration and 15 patients(33.33%)showing nerve invasion.Among 35 surgical patients(77.78%),15 underwent simple cholecystectomy,12 underwent radical cholecystectomy,and 8 underwent extended cholecystectomy.Median survival times for gallbladder squamous and adenocarcinoma patients with and without surgery were 15.57 months and 7.85 months(χ^(2)=5.691,P=0.017).Male(HR=2.596,95%CI:1.055-6.386,P=0.038),history of smoking(HR=6.983,95%CI:2.367-20.604,P<0.001)or drinking(HR=4.011,95%CI:1.339-11.971,P=0.013),liver infiltration(HR=4.607,95%CI:1.758-12.077,P=0.002)and N 2 staging(HR=6.097,95%CI:1.752-21.221,P=0.004)were the risk factors of death,surgical treatment(HR=0.310,95%CI:0.114-0.841,P=0.021)and early stage of diagnosis(Ⅰstage HR=0.275,95%CI:0.028-2.725,P=0.027;Ⅱstage HR=0.207

关 键 词：胆囊恶性肿瘤 胆囊鳞癌 胆囊腺鳞癌 临床诊疗 预后 

分 类 号：R735.8[医药卫生—肿瘤]