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  • Title: [A multicenter retrospective study for the prognosis of T1b stage gallbladder carcinoma underwent different surgical procedure].
    Author: Liu P, Zhang XB, Geng ZM, Zhai WL, Qiu YH, Song TQ, He Y, Li JD, Li SP, Tang ZH, Gong P.
    Journal: Zhonghua Wai Ke Za Zhi; 2018 May 01; 56(5):355-359. PubMed ID: 29779311.
    Abstract:
    Objective: To explore the prognosis of patients with T1b stage gallbladder carcinoma underwent different surgical procedure. Methods: The clinicopathological data of 97 patients with T1b stage gallbladder carcinoma came from 8 clinical centers from January 2010 to December 2016 and 794 patients who were admitted to the SEER database of USA from January 1973 to December 2014 were analyzed.There were 891 patients including 254 males and 637 females (1.0∶2.5) with age of (69.5±12.0)years. There were 380 patients who were less than 70 years old, 511 patients who were more than 70 years old. And there were 213 patients with the diameter of tumor less than 20 mm, 270 patients with the diameter of tumor more than 20 mm, 408 patients were unclear. There were 196 patients with well differentiation, 407 patients with moderately differentiation, 173 patients with poorly differentiation, 8 patients with undifferentiated, 107 patients were unclear. In the 891 patients with T1b stage gallbladder carcinoma, there were 562 cases accepted the simple cholecystectomy, 231 cases with simple cholecystectomy plus lymphadenectomy, and 98 cases with radical cholecystectomy. The time of follow-up were until June 2017. χ(2) test was used to analyze the enumeration data, rank-sum test was used to analyze the measurement data, the analyses of prognostic factors were used Cox proportional hazards model, the survival analysis was performed using Kaplan-Meier method. Results: The results of Cox proportional hazards model indicated, age, differentiation, surgical procedure were the risk factors of prognostic(1.929(1.594-2.336), P<0.01; 1.842(1.404-2.416), P<0.01; 1.216(0.962-1.538), P<0.01). The results of Kaplan Meier test indicated, the overall survival of T1b stage gallbladder carcinoma were (85.5±3.8)months, the overall survival of patients with simple cholecystectomy were (71.3±4.4)months, the overall survival of patients with cholecystectomy plus lymphadenectomy were(87.6±5.8)months, and the overall survival of patients with radical cholecystectomy were(101.7±9.3)months. The overall survival of patients with cholecystectomy plus lymphadenectomy and radical cholecystectomy were more than simple cholecystectomy(P<0.05). There were 329 patients with Lymph nodes examined in and after operations(231 patients with cholecystectomy plus lymphadenectomy, 98 patients with radical cholecystectomy). There were 265 patients with negative lymph node metastasis, the overall survival were(98.3±4.2)months. There were 64 patients with positive lymph node metastasis, the overall survival were(75.5±3.1)months. The overall survival of 38 patients with cholecystectomy plus lymphadenectomy were(62.7±2.6) months, and 26 patients with radical cholecystectomy were (82.2±3.7)months. The overall survival of patients with radical cholecystectomy were more than cholecystectomy plus lymphadenectomy(P<0.05). Conclusions: The T1b stage gallbladder carcinoma patients with cholecystectomy plus lymphadenectomy or radical cholecystectomy has improved the prognosis comparing with simple cholecystectomy, significantly. When lymph node metastasis occurs, radical cholecystectomy has improved the prognosis comparing with cholecystectomy plus lymphadenectomy. 目的： 探讨T1b期胆囊癌患者接受不同手术方式治疗的预后情况。 方法： 回顾性收集和分析国内8家医疗中心2010年1月至2016年12月收治的97例T1b期胆囊癌患者的临床资料和美国SEER数据库登记的1973年1月至2014年12月随访资料完整的794例T1b期胆囊癌患者的临床资料。其中男性254例，女性637例，男女比例为1.0∶2.5；发病年龄为(69.5±12.0)岁。<70岁者380例，≥70岁者511例；肿瘤最大径<20 mm者213例，≥20 mm者270例，不明确408例；高分化196例，中分化407例，低分化173例，未分化8例，不明确107例。891例T1b期胆囊癌患者中，接受胆囊切除术562例，接受胆囊切除加淋巴结清扫231例，接受胆囊癌根治术98例。随访截至2017年6月。计数资料采用χ(2)检验，计量资料采用秩和检验，预后因素分析采用Cox比例风险回归模型，生存分析采用Kaplan Meier法。 结果： Cox比例风险回归模型的分析结果显示，年龄、分化程度和手术方式是影响胆囊癌患者的预后因素[1.929(1.594～2.336)，P<0.01；1.842(1.404～2.416)，P<0.01；1.216(0.962～1.538)，P<0.01]。Kaplan Meier法的分析结果显示，T1b期胆囊癌患者的总体生存时间为(85.5±3.8)个月，胆囊切除术组患者的生存时间为(71.3±4.4)个月，胆囊切除加淋巴结清扫组患者的生存时间为(87.6±5.8)个月，胆囊癌根治术组患者的生存时间为(101.7±9.3)个月。与胆囊切除术组相比，胆囊切除加淋巴结清扫组和胆囊癌根治术组患者的生存时间明显延长(P<0.05)。共329例患者(SC＋L组231例，RC组98例)术中及术后进行淋巴结送检，淋巴结阴性患者265例，总体生存时间(98.3±4.2)个月；淋巴结阳性患者64例，总体生存时间(75.5±3.1)个月。64例淋巴结阳性患者中，SC＋L组38例，总体生存时间为(62.7±2.6)个月，RC组26例，总体生存时间为(82.2±3.7)个月。与SC＋L组相比，RC组总体生存时间明显延长(P<0.05)。 结论： 与胆囊切除术相比，胆囊切除加淋巴结清扫或胆囊癌根治术均能改善T1b期胆囊癌患者的预后；当存在区域淋巴结浸润时，与胆囊切除加淋巴结清扫相比，胆囊癌根治术能明显改善预后。.
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