Chinese Journal of Practical Surgery

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  • Online:2021-01-01 Published:2021-01-22

中国胆囊癌外科治疗现状与病理学特征多中心回顾性研究（附4345例报告）

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  1. 1上海交通大学医学院附属仁济医院胆胰外科 ，上海200127；
    2上海市肿瘤研究所 癌基因及相关基因国家重点实验室，上海 200127；3上海市胆道疾病研究重点实验室，上海 200092；4上海交通大学医学院附属新华医院普外科 200092；5安徽医科大学第一附属医院肝胆胰外科，安徽合肥 230022；6上海交通大学医学院附属新华医院崇明分院普通外科 ，上海202150；7常熟市第一人民医院普通外科 ，江苏常熟215500；8常州市第二人民医院肝胆胰外科 ，江苏常州213003；9海军军医大学东方肝胆外科医院胆道外科，上海 200438；10上海市奉贤区中心医院普通外科 ，上海201499；11湖南省人民医院肝胆外科，湖南长沙 410001；12哈尔滨医科大学附属第一医院肝胆胰外科 ，黑龙江哈尔滨150009；13哈尔滨医科大学附属第二医院胆胰外科 ，黑龙江哈尔滨150086；14哈尔滨医科大学附属肿瘤医院肝胆胰外科 ，黑龙江哈尔滨150081；15吉林大学中日联谊医院胃肠外科，吉林长春 130033；16昆明医科大学第一附属医院普通外科，云南昆明650031；17南昌大学第一附属医院普通外科 ，江西南昌330019；18南通市肿瘤医院肝胆外科 ，江苏南通226361；19青岛大学附属医院肝胆胰外科 ，山东青岛266555；20山东省立医院肝胆外科，山东济南 250021；21绍兴第二医院普通外科 ，浙江绍兴312000；22山西省肿瘤医院普通外科，山西太原 030013；23太仓市第一人民医院胃肠外科 ，江苏太仓215400；24台州市立医院肿瘤外科 ，浙江台州318000；25南京医科大学附属无锡第二医院肝胆外科，江苏无锡214002；26温州医科大学附属第一医院普通外科，浙江温州325015；27西安交通大学第一附属医院肝胆外科 ，陕西西安710061；28中国医科大学附属盛京医院肝胆外科，辽宁沈阳 110004；29浙江大学医学院附属第二医院肝胆胰外科，浙江杭州 310009

Abstract:

A largescale multicenter retrospective study of current surgical treatment modalities and pathological characteristics of patients with gallbladder cancer in China: a report of 4,345 cases        SUN Xu-heng*, REN Tai, GENG Ya-jun, et al. *Department of Pancreatobiliary Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China；Shanghai Cancer Institute, State Key Laboratory for Oncogenes and Related Genes, Shanghai 200127, China
Corresponding author: LIU Ying-bin, E-mail:laoniulyb@163.com
Abstract    Objective    To investigate the current status of surgical treatment, pathological characteristics and prognosis of patients with gallbladder cancer in China. Methods    The data of 4,345 patients with gallbladder cancer admitted to 26 hospitals in 13 provinces and cities in China from January 2010 to December 2017 were retrospectively collected. The regional, gender, and age distribution of gallbladder cancer patients in China were summarized and analyzed. Based on medical records and examination results of patients, we evaluated the resectability of tumors in patients treated by surgery, summarized and analyzed the surgical treatment modalities of patients with resectable tumors, and evaluated resectable tumor surgery with reference to the results of preoperative examinations, surgical records and postoperative pathological examinations to estimate whether the treatment meets the standard of radical resection. Results    Among the 4,345 patients with gallbladder cancer included in this study, males accounted for 1,664 (38.23%) and females accounted for 2,681 (61.77%). 3,129 (71.01%) patients underwent surgical treatment, including 2,074 (66.28%) patients with resectable tumors, and only 1,133 (54.63%) patients with resectable tumors were diagnosed as gallbladder malignancies before surgery. 1,002 cases (48.31%) of resectable tumors underwent radical resection, and 1072 (51.69%) cases did not meet the criteria for radical resection. According to the pathological results of patients with radical resection of gallbladder cancer, 736 cases (73.45%) were adenocarcinoma, 348 cases (34.73%) were poorly differentiated, 376 cases (37.52%) had liver invasion, and 152 cases (15.17%) had nerve infiltration, 96 cases (9.58%) had intravascular tumor thrombi, 78 cases (7.78%) had peripheral fatty tissue infiltration, 89 cases (8.88%) had peripheral organ involvement, and 328 cases (32.73%) had positive results of lymph node biopsy. The postoperative median survival time of 2,357 surgically treated patients with survival follow-up data was 16.17 months. The results of multivariate Cox regression survival analysis showed TNM staging(P<0.001), tumor differentiation (P<0.001), liver invasion (P<0.001), R0 resection (P=0.003) are independent prognostic factors for overall survival after surgery. Conclusions    The preoperative diagnosis rate of gallbladder cancer in China needs to be improved and the surgical treatment modalities of gallbladder cancer needs to be standardized; multiple factors reported in pathological files are closely related to the prognosis of patients with gallbladder cancer, the standardization of pathological description may be of great significance in guiding the precise treatment of patients with gallbladder cancer.

Key words: gallbladder cancer, surgical treatment, pathological features, prognosis

摘要： 目的    探讨中国胆囊癌病人的外科治疗模式、病理学特征和预后。方法    收集中国13个省市的26家医院自2010年1月至2017年12月收治的4345例胆囊癌病人临床资料，分析中国胆囊癌病人的地区、性别、年龄分布；基于病人的诊疗记录与检查结果对手术病人肿瘤的可切除性进行评估，分析可切除性肿瘤病人的外科治疗模式，参照术前检查、手术记录和术后病理学检查结果评估可切除性肿瘤手术治疗是否达到根治标准，分析行根治性手术胆囊癌病人的病理学特征。结果    4345例胆囊癌病人中，男性1664例（38.23%），女性2681例（61.77%）。行外科手术治疗的病人3129例（71.01%），其中可切除性肿瘤2074例（66.28%）。在可切除性肿瘤2074例病人中，仅1133例（54.63%）在术前即诊断为胆囊恶性肿瘤，1002例（48.31%）行根治性切除，1072例（51.69%）未达根治标准。胆囊癌根治性切除病人的病理学检查结果中，736例（73.45%）为腺癌，348例（34.73%）为低分化癌，376例（37.52%）伴肝侵犯，152例（15.17%）伴神经浸润，96例（9.58%）伴血管内癌栓，78例（7.78%）伴周围脂肪组织浸润，89例（8.88%）伴周围器官受累，328例（32.73%）活体组织病理学检查淋巴结阳性。获得生存随访资料的2357例手术治疗病人术后中位生存期为16.17个月，多因素Cox回归生存分析结果显示肿瘤TNM分期（P<0.001）、肿瘤分化程度（P<0.001）、肝脏侵犯（P<0.001）、R0切除（P=0.003）均为术后生存期的独立预后因素。结论    中国胆囊癌术前诊断率有待提高；胆囊癌外科治疗模式亟待规范；病理学检查报告中反映的多个因素与胆囊癌病人预后密切相关，其描述的规范化对指导胆囊癌病人的精准治疗有重要意义。

关键词: 胆囊恶性肿瘤, 外科治疗, 病理特征, 预后