T1b 期胆囊癌的根治性切除术：决策分析。
Radical resection for T1b gallbladder cancer: a decision analysis.
出版信息
HPB (Oxford). 2009 Dec;11(8):656-63. doi: 10.1111/j.1477-2574.2009.00108.x.
BACKGROUND
Gallbladder cancer is the most common malignancy of the biliary tract. Radical surgery (including liver resection and regional lymphadenectomy) is applied for some gallbladder cancers, but the benefits of these procedures are unproven. For patients with T1b cancers discovered incidentally on cholecystectomy specimens, the utility of radical surgery remains debated.
METHODS
A decision analytic Markov model was created to estimate and compare life expectancy associated with management strategies for a simulated cohort of patients with incidentally discovered T1b gallbladder cancer after routine cholecystectomy. In one strategy, patients were treated with no additional surgery; in another, patients were treated with radical resection. The primary (base-case) analysis was calculated based on a cohort of 71-year-old females and incorporated best available input estimates of survival and surgical mortality from the literature. Sensitivity analysis was performed to assess the effects of model uncertainty on outcomes.
RESULTS
In the base-case analysis, radical resection was favoured over no further surgical resection, providing a survival benefit of 3.43 years for patients undergoing radical resection vs. simple cholecystectomy alone. Sensitivity analysis on the age at diagnosis demonstrated that the greatest benefit in gained life-years was achieved for the youngest ages having radical resection, with this benefit gradually decreasing with increasing age of the patient. High peri-operative mortality rates (>/=36%) led to a change in the preferred strategy to simple cholecystectomy alone.
CONCLUSIONS
Decision analysis demonstrates that radical resection is associated with increased survival for most patients with T1b gallbladder cancer.
背景
胆囊癌是胆道系统最常见的恶性肿瘤。根治性手术（包括肝切除术和区域淋巴结清扫术）适用于某些胆囊癌患者，但这些手术的益处尚未得到证实。对于在胆囊切除标本中偶然发现的 T1b 期癌症患者，根治性手术的效用仍存在争议。
方法
我们创建了一个决策分析马尔可夫模型，以估计和比较偶然发现的 T1b 期胆囊癌患者在常规胆囊切除术后接受不同治疗策略的预期寿命。在一种策略中，患者不接受额外手术；在另一种策略中，患者接受根治性切除术。主要（基础案例）分析基于 71 岁女性的队列，并结合了文献中生存和手术死亡率的最佳可用输入估计值。进行敏感性分析以评估模型不确定性对结果的影响。
结果
在基础案例分析中，与单纯胆囊切除术相比，根治性切除术更有利于患者，可使接受根治性切除术的患者的生存获益增加 3.43 年。对诊断年龄的敏感性分析表明，接受根治性切除术的最年轻患者获得的生存获益最大，随着患者年龄的增加，获益逐渐减少。较高的围手术期死亡率（≥36%）导致首选策略更改为单纯胆囊切除术。
结论
决策分析表明，对于大多数 T1b 期胆囊癌患者，根治性切除术与生存获益增加相关。
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