原发性胆囊癌的治疗策略和预后分析
Analysis of treatment and prognosis of primary gallbladder cancer
目的 探讨原发性胆囊癌的治疗策略及影响患者预后的因素.方法 回顾性分析2000年1月至2009年12月天津医科大学附属肿瘤医院收治的135例原发性胆囊癌患者的临床资料,Kaplan-Meier法绘制生存曲线,生存情况分析采用Log-rank检验.对可能影响预后的因素进行单因素方差分析,多因素分析采用COX回归模型.结果 本组135例原发性胆囊癌患者的总体1、3、5年生存率分别为46.7%、10.4%和5.2%;74例接受根治性手术的患者1、3、5年生存率分别为68.9%、18.9%和9.5%;50例接受姑息性手术治疗的患者1、3、5年生存率分别为24.0%、0、0;11例接受保守治疗的患者1、3、5年生存率均为0;不同治疗方式患者的生存率比较,差异有统计学意义(x2 =5.642,P<0.05).LC术后诊断为胆囊癌并接受二次手术治疗的9例患者中,l例Ⅰ期患者、3例Ⅱ期根治性手术患者中各有1例生存时间超过5年,而5例Ⅱ期姑息性手术患者生存时间<5年,3类患者生存情况比较,差异有统计学意义(x2=5.642,P<0.05).相同TNM分期(Ⅱ、ⅢA、ⅢB、ⅣA、ⅣB期)接受根治性手术的患者的生存率明显高于接受姑息性手术和保守治疗的患者( x2 =8.971,21.250,44.153,6.696,21.722,P<0.05).单因素分析结果表明,患者的年龄、CA19-9、TNM分期和治疗方式是影响患者中位生存时间的相关因素(x2=8.466,3.977,9.837,5.642,P<0.05).多因素分析结果显示,患者年龄、TNM分期及治疗方式是影响患者中位生存时间的独立危险因素(Wald=5.779,14.724,11.640,P<0.05).结论 原发性胆囊癌患者预后较差.年龄、TNM分期及治疗方式是影响胆囊癌患者预后的独立危险因素,根治性手术治疗预后相对较好.
更多Objective To investigate the treatment strategies and factors influencing the prognosis of patients with primary gallbladder carcinoma.Methods The clinical data of 135 patients with primary gallbladder cancer who were admitted to the Cancer Hospital of Tianjin Medical University from January 2000 to December 2009 were retrospectively analyzed.The survival curve was drawn by the Kaplan-Meier method,and the survival rates were analyzed by using the Log-rank test.Factors which may have influences on the prognosis were analyzed by univariate analysis and COX multivariate analysis.Results The overall 1-,3-,5-year survival rates of the 135 patients were 46.7%,10.4% and 5.2%,respectively.The 1-,3-,5-year survival rates of 74 patients who received radical resection of gallbladder cancer were 68.9%,18.9% and 9.5%,respectively.The 1-,3-,5-year survival rates of 50 patients who received palliative treatment were 24.0%,0 and 0,respectively.The 1-,3-,5-year survival rates of 11 patients who received conservative treatment were 0,0 and 0,respectively.There was no significant difference in the survival rates among patients who received different treatment methods (x2 =5.642,P < 0.05 ). Of the 9 patients with gallbladder cancer who received reoperation after laparoscopic choledochotomy,the survival time of 1 patient in stage Ⅰ and 1 of the 3 patients in stage Ⅱ who received radical surgery exceeded 5 years,while the survival time of 5 patients in stage Ⅱ who received palliative treatment was shorter than 5 years.There was a significant difference in the survival time among the 3 groups of patients ( x2 =5.642,P<0.05).Under the condition of same TNM stages ( Ⅱ,ⅢA,ⅢB,ⅣA,ⅣB),the survival rates of patients who received radical resection of gallbladder cancer were significantly higher than those who received palliative or conservative treatment ( x2 =8.971,21.250,44.153,6.696,21.722,P < 0.05 ).The results of univariate analysis showed that age,CA19-9,TNM stages and treatment methods were risk factors influencing the median survival time ( x2 =8.466,3.977,9.837,5.642,P < 0.05 ).The results of multivariate analysis showed that age,TNM stages and treatment methods were the independent risk factors influencing the median survival time ( Wald=5.779,14.724,11.640,P<0.05).Conclusion The prognosis of primary gallbladder cancer is poor.Age,TNM stages and treatment methods are the independent factors influencing the prognosis of patients with gallbladder cancer,and patients who receive radical resection have relatively good prognosis.
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