摘要
目的通过对Ⅳ期胆囊癌患者进行预后相关因素分析,探讨从根治性手术中获益的胆囊癌患者的相关因素。方法选取西安交通大学第一附属医院及延安大学咸阳医院2008~2012年285例行手术治疗的Ⅳ期胆囊癌患者,收集病理资料和随访结果,进行生存分析。结果 1、2和3年总生存率分别为7.9%、2.2%和0.8%。年龄>65岁、远处转移和R1/2切除是胆囊癌预后的独立危险因素。与R1/2切除相比,R0切除患者的生存时间明显增加(6.0VS2.7月,P<0.001)。ⅣA期患者可从R0切除中获益(R0VS R1/2,11.0VS 3.7月,P=0.038);对于无远处转移的ⅣB期患者,R0可改善预后(R0VS R1/2,6.0VS 3.0月;P=0.004)。结论胆囊癌的第二站淋巴结转移(N2)并非根治性手术禁忌症,根治性手术可改善Ⅳ期胆囊癌患者的预后。
Objective To analyze the prognostic factors in patients with stage IV GBC, and identify benefit from R0 resection. Methods Clinicopathologic features and survival outcomes were analyzed in 285 GBC patients underwent surgery between 2008 and 2012. Results The 1-, 2-and 3-year over all survival rates were 7.9%, 2.2%, and 0.8%, respectively. More than 65 years old, M1 status, R1/2 resection were independent risk factors affecting GBC prognosis. The mean survival time （MST） was significantly higher in patients underwent R0 resection compared with R1/2 resection （6.0 vs 2.7 months; P〈0. 001）. Stage IVA patients benefited from R0 resection （MST for R0 vs R1/2, 11.0 vs 3.7 months; P=0. 038）, while R0 resection provided a significant survival benefit over R1/2 resection in stage IVB patients without distant metastasis （MST for R0 vs R1/2, 6.0 vs 3.0 months; P= 0. 004）. Conclusion N2 lymph node metastasis does not preclude curative resection. R0 resection should be considered in highly selected stage IV GBC patients.
作者
孟强劳
耿智敏
姚春和
王林
陈晨
李文智
陶杰
MENG Qianglao1 , GENG Zhimin1, YAO Chunhe2 , WANG Lin1 , CHEN Chen1 , LI Wenzhi1 , TAO Jie1(1. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi＇an Jiaotong University, Xi＇an 712000, China; 2. Department of Hepatobiliary Surgery, Xianyang Hospital of Yan＇an Universtiy Xianyang 712000, Xi＇an, Chin)
出处
《西部医学》
2018年第4期507-513,共7页
Medical Journal of West China
基金
国家自然科学基金(81572420)
关键词
胆囊癌
手术
预后
TNM分期
Gallbladder cancer
Surgery
Prognosis
TNM stage
