CAJ | 학술논문

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.
목적 탐토원발성담낭암적치료책략급영향환자예후적인소.방법 회고성분석2000년1월지2009년12월천진의과대학부속종류의원수치적135례원발성담낭암환자적림상자료,Kaplan-Meier법회제생존곡선,생존정황분석채용Log-rank검험.대가능영향예후적인소진행단인소방차분석,다인소분석채용COX회귀모형.결과 본조135례원발성담낭암환자적총체1、3、5년생존솔분별위46.7％、10.4％화5.2％；74례접수근치성수술적환자1、3、5년생존솔분별위68.9％、18.9％화9.5％；50례접수고식성수술치료적환자1、3、5년생존솔분별위24.0％、0、0；11례접수보수치료적환자1、3、5년생존솔균위0；불동치료방식환자적생존솔비교,차이유통계학의의(x2 =5.642,P＜0.05).LC술후진단위담낭암병접수이차수술치료적9례환자중,l례Ⅰ기환자、3례Ⅱ기근치성수술환자중각유1례생존시간초과5년,이5례Ⅱ기고식성수술환자생존시간＜5년,3류환자생존정황비교,차이유통계학의의(x2=5.642,P＜0.05).상동TNM분기(Ⅱ、ⅢA、ⅢB、ⅣA、ⅣB기)접수근치성수술적환자적생존솔명현고우접수고식성수술화보수치료적환자( x2 =8.971,21.250,44.153,6.696,21.722,P＜0.05).단인소분석결과표명,환자적년령、CA19-9、TNM분기화치료방식시영향환자중위생존시간적상관인소(x2=8.466,3.977,9.837,5.642,P＜0.05).다인소분석결과현시,환자년령、TNM분기급치료방식시영향환자중위생존시간적독립위험인소(Wald=5.779,14.724,11.640,P＜0.05).결론 원발성담낭암환자예후교차.년령、TNM분기급치료방식시영향담낭암환자예후적독립위험인소,근치성수술치료예후상대교호.
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.