胆囊腺鳞癌与胆囊腺癌的临床病理特征对比以及预后影响因素分析
Comparison of clinicopathological features and prognostic analysis between patients with gallbladder adenosquamous carcinoma and gallbladder adenocarcinoma
张雪明 1张雷明 1成功1
作者信息
- 1. 宁波市医疗中心李惠利医院肝胆胰外科,宁波 315100
- 折叠
摘要
目的 对比胆囊腺鳞癌患者与胆囊腺癌患者的临床病理特征及分析预后影响因素.方法 回顾性分析2018年1月至2022年12月宁波市医疗中心李惠利医院肝胆胰外科接受手术治疗的135例胆囊癌患者临床资料.最终入组122例患者,其中男性55例,女性67例,年龄(68.0± 9.8)岁.122例患者依据肿瘤病理类型不同,分为胆囊腺鳞癌组(n=14)和胆囊腺癌组(n=108).比较两组患者肿瘤最大径、肿瘤分化程度、肿瘤TNM分期等临床病理特征及预后.采用Kaplan-Meier法计算生存率,生存率比较采用log-rank检验.进一步采用多因素Cox回归分析术后预后影响因素.结果 胆囊腺鳞癌组肿瘤最大径、肝脏侵犯比例、肿瘤低分化比例以及TNM分期Ⅲ～Ⅳ期比例高于胆囊腺癌组,差异均有统计学意义(均P＜0.05).两组肝切除范围比较,差异有统计学意义(x2=9.22,P=0.016).胆囊腺鳞癌组术后1、2年累积生存率分别为28.6％、9.5％,低于胆囊腺癌组的78.7％、60.5％,差异有统计学意义(x2=27.88,P＜0.001).胆囊腺鳞癌组中接受术后辅助治疗的患者(n=11)术后累积生存率优于未接受术后辅助治疗的患者(n=3),差异有统计学意义(x2=5.82,P=0.016).多因素 Cox 回归分析显示,N 分期(N1/N0HR=4.521,95％CI:1.399～14.612,P=0.012;N2/N0HR=8.644,95％CI:2.407～31.039,P=0.001)、M 分期(M1/M0HR=4.699,95％CI:1.540～14.340,P=0.007)的胆囊腺癌患者术后死亡风险增加.结论 胆囊腺鳞癌比胆囊腺癌更具侵袭性,预后更差.术后早期辅助治疗与胆囊腺鳞癌患者预后相关,而N分期、M分期是胆囊腺癌患者术后生存的危险因素.
Abstract
Objective To compare the clinicopathological features between patients with gallbladder adenosquamous carcinoma and gallbladder adenocarcinoma,and analyze the prognostic factors for overall survival.Methods The clinical data of 135 patients with gallbladder cancer,confirmed by postoperative pathology,treated in Department of Hepatobiliary and Pancreatic Surgery of Ningbo Medical Center Lihuili Hospital within 5 years(from January 2018 to December 2022)were retrospectively analyzed.A total of 122 patients were enrolled in this study,including 55 males and 67 females,aged(68.0±9.8)years.Patients were divided into the adenosquamous carcinoma group(n=14)and adenocarcinoma group(n=108).The clinicopathological features(tumor size,differentiation of tumor,tumor TNM stage)and survivals of patients were compared.The survival rates were analyzed using the Kaplan-Meier method and log-rank test.Multiva-riate Cox regression analysis was performed to identify prognostic factors for overall survival.Results Com-pared with the adenocarcinoma group,patients with adenosquamous carcinoma had a larger tumor size,higher incidence of liver invasion,higher proportion of poor differentiation of tumor,higher proportion of TNM stageⅢ-Ⅳ(all P＜0.05).There was also a statistically significant difference in the extent of liver resection between the two groups(X2=9.22,P=0.016).The 1-and 2-year cumulative survival rates after surgery in adenosquamous carcinoma group were 28.6％and 9.5％,respectively,lower than those in adenocarcinoma group(78.7％and 60.5％,respectively;x2=27.88,P＜0.001).For patients with gallbladder adeno-squamous carcinoma,the cumulative survival rate of patients who received postoperative adjuvant chemother-apy(n=11)was significantly better than that of patients without postoperative adjuvant chemotherapy(n=3)(x2=5.82,P=0.016).For patients with gallbladder adenocarcinoma,multivariate Cox regression analysis identified that the N stage(N1/N0 HR=4.521,95％CI:1.399-14.612,P=0.012;N2/N0 HR=8.644,95％CI:2.407-31.039,P=0.001)and M stage(M1/M0 HR=4.699,95％CI:1.540-14.340,P=0.007)were associated with a poor survival.Conclusions Compared to gallbladder adenocar-cinoma,adenosquamous carcinoma had more aggressive features and a worse prognosis.For patients with gallbladder adenosquamous carcinoma,postoperative adjuvant chemotherapy was associated with an improved overall survival.For patients with gallbladder adenocarcinoma,N stage and M stage were independent risk factors for overall survival.
关键词
胆囊/癌,腺鳞状/腺癌/预后/治疗Key words
Gallbladder/Carcinoma,adenosquamous/Adenocarcinoma/Prognosis/Treat-ment引用本文复制引用
出版年
2024
NETL
NSTL
万方数据