根治性手术可使Ⅳ期胆囊癌患者获益

摘要

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.%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(6.0 VS2.7月,P＜0.001).ⅣA期患者可从R0切除中获益(R0 VS R1/2,11.0 VS 3.7月,P=0.038);对于无远处转移的ⅣB期患者,R0可改善预后(R0 VS R1/2,6.0 VS 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.