中国实用外科杂志

中国实用外科杂志

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胆囊神经内分泌肿瘤临床病理特征及预后影响因素分析

谢智华1，张吉祥1，程庆保1，施学兵1，王敬晗2，于    勇1，刘明奇1，李    炜1，储开健1，姜小清1   

  1. 1 海军军医大学第三附属医院（东方肝胆外科医院）胆道一科，上海 200438；2 同济大学附属东方医院肝胆胰外科，上海 200120
  • 出版日期:2023-02-01

  • Online:2023-02-01

摘要： 目的    探索胆囊神经内分泌肿瘤病人预后影响因素并构建该类型肿瘤的生存预测模型。方法    回顾性分析2012—2021年海军军医大学第三附属医院35例胆囊神经内分泌肿瘤病人临床病理学资料。采用单因素及多因素方法分析预后影响因素，构建列线图并绘制校准曲线评估模型预测效能。结果    35例病人中,混合型神经内分泌肿瘤15例，神经内分泌癌20例。病人年龄（57.8±10.9）岁。 35例病人中位总生存期为16.2 个月，1、2、3年总生存率分别为59.1%、38.7%、38.7%。脉管癌栓、外科手术是总生存期独立危险因素，远处转移是总生存期重要影响因子，并据此成功构建生存预测模型。该模型C-指数为0.739（95%CI 0.633-0.845），1、2、3年受试者工作特征曲线下面积（ROC-AUC）分别为0.706、0.795、0.795，且校准曲线表明模型预测一致性较好。结论    脉管癌栓、外科手术和远处转移是胆囊神经内分泌肿瘤总生存期重要影响因素，据此构建的生存预测模型具有较好的区分度和准确度，有助于辅助临床决策的制定。

关键词: 胆囊癌, 神经内分泌肿瘤, 神经内分泌癌

Abstract: Analysis of clinicopathological features and prognostic factors of gallbladder neuroendocrine neoplasms                      XIE Zhi-hua*, ZHANG Ji-xiang, CHENG Qing-bao, et al.*Department I of Biliary Tract, the Third Affiliated Hospital of Naval Medical University（Eastern Hepatobiliary Surgery Hospital）, Shanghai 200438, China 
Corresponding author: JIANG Xiao-qing, E-mail: jxq1225@sina.com
XIE Zhi-hua and ZHANG Ji-xiang are the first authors who contributed equally to the article
Abstract    Objective    To explore the prognostic factors of patients with neuroendocrine neoplasms of the gallbladder and build a survival prediction model. Methods    The clinicopathological data of 35 cases of gallbladder neuroendocrine neoplasms in the Third Affiliated Hospital of Naval Medical University from 2012 to 2021 were retrospectively analyzed. Univariate and multivariate methods were used to analyze prognostic factors, a nomogram was constructed, and a calibration curve was drawn to evaluate the predictive performance of the model. Results    Among the 35 patients, 15 were mixed neuroendocrine tumors and 20 were neuroendocrine carcinomas, with an age of 57.8±10.9 years. The median overall survival of 35 patients was 16.2 months, the 1-, 2- and 3-year overall survival rate was 59.1%, 38.7% and 38.7%, respectively. Vascular tumor thrombus and operation were independent risk factors for overall survival, and distant metastasis was an important factor for overall survival. A nomogram of overall survival was successfully established based on these three factors. The C-index of the model was 0.739 (95%CI 0.633-0.845), and the area under the time-dependent receiver operating characteristic curves of nomogram at 1-, 2- and 3-year were 0.706, 0.795 and 0.795, respectively. The calibration curves showed that predictions were in good agreement with the observations at 1-, 2-and 3-years. Conclusion Vascular tumor thrombus, operation, and distant metastasis were important prognostic factors of overall survival for gallbladder neuroendocrine neoplasms. The survival prediction model constructed based on the three factors has a good degree of discrimination and accuracy, helping to assist clinical decision-making.

Key words: gallbladder cancer, neuroendocrine neoplasm, neuroendocrine carcinoma