胆囊癌的临床分型和预后关系初步分析:多中心回顾性临床研究

摘要

目的 提出新的胆囊癌临床分型,探讨不同临床分型胆囊癌患者的临床病理学特征及根治性术后生存时间的差异.方法 回顾性分析中国12家医学中心2013年1月至2017年12月收治的经根治性手术治疗的1 059例胆囊癌患者的临床病理学资料,其中男性389例,女性670例,男女比例为1.0:1.7;年龄(62.0±10.5)岁(范围:22 ～ 88岁).按照肿瘤生长部位和浸润方式分为腹腔型、肝脏型、肝门型和混合型,手术方式分为区域性根治切除和扩大性根治切除.分析患者整体临床病理学特征;不同分型与T分期、N分期、血管侵犯及神经浸润的相关性等.计数资料的比较采用x2检验,生存分析采用Kaplan-Meier法和Log-rank检验.结果 1 059例胆囊癌患者中,区域性根治性切除940例,其中T1期81例,T2期及以上859例;扩大性根治性切除119例.总体R0切除990例(93.5％).总体中位生存时间为28个月.Tis ～ T1期患者81例,T2期及以上患者978例.T2期及以上患者腹腔型345例(35.3％)、肝脏型331例(33.8％)、肝门型122例(12.5％)、混合型180例(18.4％).T分期(x2=288.60,P＜0.01)、N分期(x2=68.10,P＜0.01)、血管侵犯(x2=128.70,P＜0.01)及神经浸润(x2=54.30,P＜0.01)与各分型之间具有相关性.腹腔型中位生存时间为48个月,肝脏型为21个月,肝门型为16个月,混合型为11个月,差异有统计学意义(x2=80.60,P＜0.01).各分型组内区域性根治切除与扩大性根治切除中位生存时间的差异均无统计学意义(P值均＞0.05).结论 胆囊癌不同临床分型与TNM分期、恶性生物学行为及预后均具有相关性,对术前评估、手术方案制定及预后评估具有指导作用.%Objectives To propose a novel clinical classification system of gallbladder cancer,and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer.Methods The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females,aged (62.0± 10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type,hepatic type,hepatic hilum type and mixed type,the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage,N stage,vascular invasion,neural invasion,median survival time and surgical procedures were analyzed.Rates were compared by x2 test,survival analysis was carried by Kaplan-Meier and Log-rank test.Results Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5％).The overall median survival time was 28 months.There were 81 patients in Tis-Tl stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage:345 cases(35.3％) of peritoneal type,331 cases(33.8％) of hepatic type,122 cases(12.5％) of hepatic hilum type and 180 cases(18.4％) of mixed type.T stage(x 2=288.60,P＜0.0 1),N stage(x2=68.10,P＜0.01),vascular invasion(x2=128.70,P＜0.01) and neural invasion(x2=54.30,P＜0.01) were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(x2=80.60,P＜0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P＞0.05).Conclusion With application of new clinical classification,different types of gallbladder cancer are proved to be correlated with TNM stage,malignant biological behavior and prognosis,which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.