摘要
目的探讨前后10年接受手术治疗的原发性胆囊癌(PCG)患者的临床特点及预后影响因素。方法回顾性分析1997年1月至2018年1月收治的320例PCG患者的临床及随访资料。按照时间顺序分为前期组(1997至2007年)98例和后期组(2008至2018年)222例。通过统计分析了解两组患者的临床特点及预后差异,进一步对后期组患者的临床资料进行单因素及多因素分析,明确影响预后的因素。结果合并胆囊结石的比例,前期组高于后期组(70.4%vs55.4%),合并胆囊息肉的比例,前期组低于后期组(29.3%vs18.4%);根治性手术比例,前期组低于后期组(48.0%vs66.7%),姑息性手术比例,前期组高于后期组(22.4%vs5.4%);接受术后化疗比例,前期组低于后期组(20.4%vs55.4%),以上差异均有统计学意义(均P<0.05)。生存分析显示后期组生存率有一定提高。后期组术后近期及远期生存率均高于前期组(均P<0.05)。进一步对后期组进行单因素及多因素预后分析,根治性手术、TNM分期、术后联合化疗是影响PCG预后的独立危险因素。结论虽然PCG的生存率近年来有了一定的提高,但仍处于较低水平。生存率的提高可能与根治性手术及辅助性化疗的开展有关。
Objective To investigate the trends in surgical treatment of primary carcinoma of the gallbladder(PCG) in two decades.Methods The clinical data of 320 patients with PCG who underwent surgical treatment in Ningbo Li Huili Hospital and Li Huili Eastern Hospital from January 1997 to January 2018 were retrospectively reviewed. There were 98 cases treated during 1997-2007(early group) and222 cases treated during 2008-2018(late group). The clinical characteristics and prognosis were analyzed in the two groups. Cox regression and Kaplan-Meier models were performed for survival analysis in late group. Results The gallbladder polyp in late group was lower than that in early group(29.3% vs. 18.4%), while the cholelithiasis in late group was higher(55.4% vs. 70.4%). The proportion of receiving radical surgery and postoperative chemotherapy in early group was lower than that those in late group(48.0% vs. 66.7%; 20.4% vs. 55.4%, both P<0.05). The univariate analysis and multivariate analysis revealed that radical resection, TNM stage and adjuvant chemotherapy were significant correlated with the survival of patients. Conclusion Although the survival time of PCG has been improved in recent years, it is still at a low level. The radical resection and adjuvant chemotherapy may improve the survival of patients.
引文
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