摘要目的 探讨胆囊腺癌术后患者预后影响因素.方法 提取美国国立癌症研究所监测、流行病学和结果(SEER)数据库2004年至2014年共1 285例行手术治疗且组织学明确诊断为胆囊腺癌患者的临床病理数据.寿命表法计算生存率;Kaplan-Meier法绘制生存曲线;单因素Log rank x2检验和多因素Cox回归分析评估胆囊腺癌患者预后的影响因素.结果 1 285例胆囊腺癌患者的中位生存期为32个月,1年、3年、5年生存率分别为77.5％、46.8％、36.5％.Ⅰ、Ⅱ、ⅢA、ⅢB、ⅣA、ⅣB期的五年生存率分别为72.7％、63.2％、24.6％、20.5％、0％、5.1％,ⅢA、ⅢB、ⅣA、ⅣB期的中位生存期分别为22、19、12、16个月,各分期的生存率差异有统计学意义(P＜0.05).单因素分析显示性别、年龄、分化程度、肿瘤直径、T分期、N分期、淋巴结检出数、淋巴结转移比率、淋巴结转移位置、美国癌症联合委员会(AJCC)分期与预后相关(P＜0.05).种族、婚姻状况与预后无明显相关性(P＞0.05).多因素Cox回归分析显示性别(男性)、年龄(≥65岁)、分化程度、T分期、淋巴结检出数(＜4)、AJCC分期是影响胆囊腺癌患者预后的独立危险因素(P＜0.05).结论 随着AJCC分期的升高,胆囊腺癌术后患者的生存率逐渐降低.性别、年龄、肿瘤分化程度、T分期、淋巴结检出数、AJCC分期等是评估胆囊腺癌术后患者生存预后的独立指标.

abstractsObjective To study the impact factors on prognosis of patients with gallbladder adenocarcinoma after surgery.Methods The clinicopathological data of 1 285 patients who underwent surgery and were histologically confirmed to have gallbladder adenocarcinoma from 2004 to 2014 was extracted from the SEER database of US National Cancer Institute.Life table was used to calculate the survival rate.Kaplan-Meier was used to construct the survival curves.Univariate and Cox multivariate regression analysis were applied to evaluate the prognostic factors.The univariate analysis was evaluated by the log-rank x2 test.Results The median survival of 1 285 patients with gallbladder adenocarcinoma was 32 months.The 1-,3-and 5-year survival rates were 77.5％,46.8％ and 36.5％,respectively.The 5-year survival rates of stage Ⅰ,Ⅱ,ⅢA,ⅢB,ⅣA,ⅣB were 72.7％,63.2％,24.6％,20.5％,0 and 5.1％,respectively.The median survival of stage ⅢA,ⅢB,ⅣA and ⅣB were 22 months,19 months,12 months and 16 months,respectively.The differences were statistically significant (P ＜ O.05).Univariate analysis showed that sex,age,degree of differentiation,tumor size,T staging,N staging,number of lymph nodes detected,lymph node metastasis rate,location of lymph node metastasis,and American Joint Commission on cancer (AJCC) staging were significantly associated with prognosis (P ＜ 0.05).There was no significant differences among race and marital status with prognosis (P ＞ 0.05).Multivariate Cox regression analysis showed that sex (male),age (≥ 65 years),degree of differentiation,T staging,number of lymph nodes detected (＜ 4)and AJCC staging were independent risk factors affecting prognosis of patients with gallbladder adenocarcinoma (P ＜ 0.05).Conclusions With increase in AJCC staging,the survival rates in patients with gallbladder adenocarcinoma after surgery decreased gradually.Parameters including sex,age,T staging,number of lymph nodes detected and AJCC staging were independent factors affecting prognosis of patients with gallbladder adenocarcinoma after surgery.