[Analysis of treatment modalities and prognosis of patients with gallbladder cancer in China from 2010 to 2017].
[Analysis of treatment modalities and prognosis of patients with gallbladder cancer in China from 2010 to 2017].
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DOI：
10.3760/cma.j.cn112139-20200403-00279
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发表时间：
2020-09-01
期刊：
影响因子：
--
通讯作者：
Liu, Y B
中科院分区：
文献类型：
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作者：
Ren, T;Li, Y S;Liu, Y B
目的：探讨中国胆囊癌（GBC）患者的临床特点及预后。方法：本回顾性多中心队列研究纳入了2010年1月至2017年12月在10个省15家医院诊断的3 528例连续GBC患者。男性1 345人（38.12%），女性2 183人（61.88%）。诊断年龄为（63.7±10.8）岁（范围：26 ~ 99岁）。0 ~Ⅰ期213例（6.04%），Ⅱ~Ⅲ期1 059例（30.02%），Ⅳ期1 874例（53.12%），无法获得治疗的382例（10.83%）。手术2 255例，占63.92%。化疗或放疗336例（9.52%），其中姑息治疗172例；1 101例（31.21%）仅接受支持性治疗。分析患者来源、治疗及手术、病理、合并胆结石及预后。结果：3 528例GBC患者中，华东地区959例（27.18%），华东地区603例（17.09%），华中地区1 533例（43.45%），西部地区433例（12.27%）。1578例可切除肿瘤中，665例（42.14%）行根治性手术，913例（57.86%）行手术，但未按指南操作。术前确诊891例（56.46%），术中确诊254例（16.10%），术后确诊381例（24.14%）（52例无法确定诊断时间点）。1578例可切除肿瘤患者中，759例（48.10%）合并胆结石。在665例接受根治性手术的患者中，69例（10.4%）显示切除边缘阳性，510例（76.7%）显示切除边缘阴性，86例（12.9%）未报告切除边缘状态。3 528例患者的5年总生存率（5yOS）为23.0%。可切除肿瘤患者的5yOS为39.6%，ⅣB期未手术患者的5yOS为5.4%，ⅣB期姑息性手术患者的5yOS为4.7%。结论：中国超过一半的GBC患者被诊断为Ⅳ期。治疗目的手术对改善可切除GBC的预后有重要价值。GBC的治疗需要进一步规范。迫切需要有效的GBC综合治疗。
Objective: To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China. Methods: This retrospective multicenter cohort study enrolled 3 528 consecutive GBC patients diagnosed between January 2010 to December 2017 in 15 hospitals from 10 provinces. There were 1 345 (38.12%) males and 2 183 (61.88%) females.The age of diagnosis was (63.7±10.8) years old (range: 26 to 99 years old) .There were 213 patients (6.04%) in stage 0 to Ⅰ, whereas 1 059 (30.02%) in stage Ⅱ to Ⅲ, 1 874 (53.12%) in stage Ⅳ, and 382 (10.83%) unavailable. Surgery was performed on 2 255 patients (63.92%) . Three hundred and thirty-six patients received chemotherapy or radiotherapy (9.52%; of which 172 were palliative); 1 101 (31.21%) received only supportive treatment.The patient source, treatment and surgery, pathology, concomitant gallstone, and prognosis were analyzed. Results: Among the 3 528 GBC patients, 959 (27.18%) were from East China, 603 (17.09%) from East-North China, 1 533 (43.45%) from Central China, and 433(12.27%) from West China. Among the 1 578 resectable tumor, 665 (42.14%) underwent radical surgery, 913 (57.86%) underwent surgery that failed to follow the guidelines.Eight hundred and ninety-one (56.46%) patients were diagnosed before surgery, 254 (16.10%) during surgery, and 381 (24.14%) after surgery (time point of diagnosis couldn't be determined in 52 patients) .Among the 1 578 patients with resectable tumor, 759 (48.10%) had concomitant gallstone.Among the 665 patients underwent radical surgery, 69 (10.4%) showed positive resection margin, 510 (76.7%) showed negative resection margin, and 86 (12.9%) unreported margin status.The 5-year overall survival rate (5yOS) for the 3 528-patient cohort was 23.0%.The 5yOS for patients with resectable tumor was 39.6%, for patients with stage ⅣB tumor without surgery was 5.4%, and for patients with stage ⅣB tumor underwent palliative surgery was 4.7%. Conclusions: More than half GBC patients in China are diagnosed in stage Ⅳ.Curative intent surgery is valuable in improving prognosis of resectable GBC.The treatment of GBC needs further standardization.Effective comprehensive treatment for GBC is in urgent need.