中国实用外科杂志

中国实用外科杂志 ›› 2022, Vol. 42 ›› Issue (07): 794-799.DOI: 10.19538/j.cjps.issn1005-2208.2022.07.19

• 论著 • 上一篇    下一篇

T3期胆囊癌淋巴结清扫范围对预后影响分析

罗    艺，刘东明，李广涛，韩智强，郭    华，陈    璐，武    强，宋天强   

  1. 国家肿瘤临床医学研究中心  天津市“肿瘤防治”重点实验室  天津市恶性肿瘤临床医学研究中心  天津医科大学肿瘤医院肝癌防治研究中心肝胆肿瘤科，天津 300060
  • 出版日期:2022-07-01 发布日期:2022-07-05

  • Online:2022-07-01 Published:2022-07-05

摘要： 目的    评估T3期胆囊癌（GBC）病人术中行标准或扩大淋巴结清扫的临床结局。方法    回顾性分析2011年1月至2016年2月天津医科大学肿瘤医院肝胆肿瘤科收治的行手术治疗的67例T3期GBC病人的临床资料。其中行标准和扩大淋巴结清扫分别为32、35例。67例病人中T分期达到T3的Ⅲ期GBC病人为56例，其中标准和扩大淋巴结清扫分别为32、24例。通过多因素回归分析评估不同淋巴结清扫范围对于局部晚期胆囊癌预后的影响。结果    对于T3期病人，N分期（HR=2.24，95%CI 1.49-3.36，P＜0.001）和淋巴结清扫范围（HR=2.51，95%CI 1.35-4.67，P=0.004）是总生存率（OS）的独立预后因素，而肝浸润（HR=2.10，95%CI 1.18-3.74，P=0.012）和胆石症（HR=2.84，95%CI 1.30-6.19，P=0.009）是无复发生存率（RFS）的独立危险因素。对于手术切除后T分期达T3期的Ⅲ期GBC病人，淋巴结清扫是OS和RFS的独立危险因素（OS：HR=2.46，95%CI 1.27-4.77，P=0.008；RFS：HR=1.99，95%CI 1.05-3.77，P=0.040），N分期是OS的独立危险因素（HR=2.29，95%CI 1.23-4.29，P=0.009），胆石症是RFS的独立危险因素（HR=2.55，95%CI 1.02-6.35，P=0.045）。结论    扩大淋巴结清扫可能有助于改善T3期GBC病人的生存，尤其是T分期达到T3的Ⅲ期GBC病人，而且与是否存在淋巴结转移无关。

关键词: 胆囊癌, 淋巴结清扫, T3期, 生存

Abstract: Analysis of lymph node dissection scope for the prognosis of patients with gallbladder cancer in T3 stage                      LUO Yi，LIU Dong-ming，LI Guang-tao，et al. Department of Hepatobiliary Cancer，Liver Cancer Research Center，Tianjin Medical University Cancer Institute and Hospital，National Clinical Research Center for Cancer，Key Laboratory of Cancer Prevention and Therapy，Tianjin’s Clinical Research Center for Cancer，Tianjin 300060，China
Corresponding authors：CHEN Lu，E-mail：chenlu@tmu.edu.cn；WU Qiang，E-mail：biliary@163.com；SONG Tian-qiang，E-mail：tjchi@hotmail.com
LUO Yi and LIU Dong-ming are the first authors who contributed equally to the article
Abstract    Objective    To evaluate the clinical outcomes of patients with gallbladder cancer（GBC） in T3 stage  undergoing different lymph node dissections. Methods    From January 2011 to February 2016, 67 patients with GBC in T3 stage (32 and 35 with standard and extended lymph node dissection, respectively) who underwent surgical treatment in the Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Hospital were retrospectively analyzed. The T stage reached T3. 56 patients with stage III GBC (standard and extended lymph node dissection were 32 and 24, respectively). Multivariate regression analysis was used to evaluate the effect of different lymph node dissection ranges on the prognosis of locally advanced gallbladder cancer, in order to provide evidence for the extent of lymph node dissection in gallbladder cancer. Results    For patients with T3 stage, N stage (HR=2.24, 95%CI 1.49-3.36, P<0.001) and extent of lymph node resection (HR=2.51, 95%CI 1.35-4.67, P=0.004) were independent prognostic factors for OS , while liver infiltration (HR=2.10, 95%CI 1.18-3.74, P=0.012) and cholelithiasis (HR=2.84, 95%CI 1.30-6.19, P=0.009) were independent risk factors for RFS. Lymph node dissection was an independent risk factor for OS and RFS in patients with stage III GBC whose T stage reached T3 after surgical resection (OS: HR=2.46, 95%CI 1.27-4.77, P=0.008; RFS: HR=1.99, 95 %CI 1.05-3.77,P=0.040), N stage was an independent risk factor for OS (HR=2.29, 95%CI 1.23-4.29, P=0.009), and cholelithiasis was an independent risk factor for RFS (HR=2.55, 95%CI 1.02- 6.35, P=0.045). Conclusion    EL may help improve the survival rate of T3 stage GBC patients，especially stage III patients，regardless of whether there is LNs metastasis.

Key words: gallbladder cancer, lymph node dissection, T3 stage, survival