Gallbladder cancer in India: A dismal picture
Gallbladder cancer in India: A dismal picture
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DOI：
10.1111/j.1440-1746.2005.03576.x
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发表时间：
2005-02-01
影响因子：
4.1
通讯作者：
Tandon, RK
中科院分区：
文献类型：
--
作者：
Batra, Y;Pal, S;Tandon, RK
背景：胆囊癌是最常见的胃肠道恶性肿瘤之一。然而，关于GBC的数据有限。方法：回顾10年来634例GBC患者的临床表现、调查结果、治疗、手术结果和预后。结果：患者平均年龄为51±11岁，男女比例为0.36:1.00。疼痛占81.0%，黄疸占76.0%，肝肿大占61.5%。在影像学上，73%的患者有肿块取代胆囊。54%的患者存在胆结石。291例（46%）患者接受手术治疗，72例（19%）患者接受内镜治疗，其余患者因疾病弥散而未进行干预。手术患者中，GBC I期占2.0%，II期占3.4%，III期占17.5%，IVa期占47.0%，IVb期占29.8%。133例（46%）患者可以根治性切除。30天死亡率为10%，其中大多数（90%）死亡为IV期疾病患者。单纯胆囊切除术和根治性手术后的中位生存期分别为33.5个月和12.0个月。然而，在单纯接受减容、姑息性旁路或探查性剖腹手术的患者中，生存期在1至3个月之间。Logistic回归分析显示，仅根治性切除可提高远期生存率（P < 0.05）。结论：印度大多数GBC患者为晚期不可切除疾病。早期发现GBC是偶然和罕见的，但与长期生存有关。根治性手术，在可行的情况下，是实现长期生存的唯一选择。(C) 2005 Blackwell出版亚洲有限公司
Background: Gallbladder cancer (GBC) is one of the most common gastrointestinal malignancies. The data regarding GBC are, however, limited.Methods: Records of 634 patients with GBC over a 10-year period were examined with regard to the clinical presentation, investigative findings, treatment, operative findings and outcome.Results: The mean age of patients was 51 +/- 11 years and men: women ratio was 0.36:1.00. Pain, jaundice and hepatomegaly were seen in 81.0%, 76.0% and 61.5% patients, respectively. On imaging, a mass replacing the gallbladder was seen in 73% patients. Gallstones were present in 54% patients. Surgery was carried out in 291 (46%) patients and endoscopic treatment in 72 (19%) patients but no intervention was carried out in the remaining patients because of disseminated disease. Among the patients who were operated on, 2.0% had stage I GBC, 3.4% stage II, 17.5% stage III, 47.0% stage IVa and 29.8% stage IVb. Radical resection was possible in 133 (46%) patients. The 30-day mortality was 10% with most (90%) deaths in patients with stage IV disease. The median survival after simple cholecystectomy and radical surgery was 33.5 and 12.0 months, respectively. However, among those who underwent debulking, palliative bypass or exploratory laparotomy alone, the survival ranged between I and 3 months. Logistic regression analysis showed that only radical resection improved the long-term survival (P < 0.05).Conclusions: The majority of patients with GBC in India have advanced unresectable disease. Detection of GBC at an early stage is incidental and rare but is associated with long-term survival. Radical surgery, when feasible, is the only option for achieving long-term survival. (C) 2005 Blackwell Publishing Asia Pty Ltd.