Shen Hao-Xin, Song Hu-Wei, Xu Xin-Jian, Jiao Zuo-Yi, Ti Zhen-Yu, Li Zhao-Yu, Ren Bin, Chen Chen, Ma Li, Zhao Ya-Ling, Zhang Guan-Jun, Ma Jian-Cang, Geng Xi-Lin, Zhang Xiao-Di, Shi Jing-Sen, Wang Lin, Geng Zhi-Min
Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China.
Department of General Surgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, Xinjiang 830054, China.
Chronic Dis Transl Med. 2017 Feb 22;3(1):60-66. doi: 10.1016/j.cdtm.2017.01.003. eCollection 2017 Mar 25.
To analyze the clinical epidemiological characteristics of patients with gallbladder carcinoma recruited from 17 hospitals in five northwestern provinces of China (Shaanxi Province, Gansu Province, Qinghai Province, Ningxia Hui Autonomous Region, and Xinjiang Uygur Autonomous Region) from 2009 to 2013, and to summarize the clinical diagnosis and treatment data of gallbladder carcinoma.
Clinical information of 2379 patients with gallbladder carcinoma from 17 hospitals in five northwestern provinces of China was retrospectively collected and analyzed using the "Questionnaire for Gallbladder Carcinoma Patients in Northwestern Area of China." All information was verified with EpiData software and analyzed with SPSS 13.0 software.
(1) Gallbladder carcinoma accounted for 2.7% (2379/86,609) of all biliary tract diseases during the study period, which was significantly higher than that from 1986 to 1998 ( 0.001). (2) Gallbladder carcinoma was more prone to occur in elderly women. The male:female incidence ratio was 1.0:2.1, the average age of onset of disease was 63.7 ± 11.3 years, and the incidence was higher in farmers than in other occupational groups. (3) A total of 57.2% (1360/2379) of patients with gallbladder carcinoma also had gallstones. (4) Abdominal pain (1796/2379, 75.5%) and jaundice (727/2379, 30.6%) were the most common clinical manifestations, 81.2% (1527/1881) were positive in those receiving B ultrasound examinations and 90.7% (1567/1727) were positive in those undergoing computed tomography, and 64.5% (1124/1742) of patients with gallbladder carcinoma were positive for carbohydrate antigen (CA) 19-9. (5) The pathological type of gallbladder carcinoma was mainly moderately and poorly differentiated adenocarcinoma with a high degree of malignancy. At admission, 55.1% (1091/1981) of patients had stage IV cancer among patients with TNM staging information; 55.9% (1331/2379) had lymphatic metastasis, 29.7% (706/2379) had bile duct metastasis, and 53.1% (1263/2379) had liver metastasis. (6) A total of 283 patients (283/2379, 11.9%) had incidentally detected gallbladder carcinoma. (7) The rate of radical surgical resection was 30.4% (723/2379).
The proportion of gallbladder carcinoma in biliary tract diseases in the northwestern area of China was significantly higher from 2009 to 2013 than from 1986 to 1998. Gallbladder carcinoma was common in older women and mainly diagnosed at an advanced stage. Compared with other surveys in different regions, the rate of metastasis in this survey was high, leading to a low resection rate. Populations at high risk should undergo B-ultrasound examinations at regular follow-up intervals to increase the rate of early diagnosis of gallbladder carcinoma.
分析2009年至2013年从中国西北五省（陕西省、甘肃省、青海省、宁夏回族自治区和新疆维吾尔自治区）17家医院招募的胆囊癌患者的临床流行病学特征，并总结胆囊癌的临床诊断和治疗数据。
回顾性收集中国西北五省17家医院2379例胆囊癌患者的临床资料，使用“中国西北地区胆囊癌患者调查问卷”进行分析。所有信息均经EpiData软件核实，并使用SPSS 13.0软件进行分析。
（1）研究期间胆囊癌占所有胆道疾病的2.7%（2379/86,609），显著高于1986年至1998年（P<0.001）。（2）胆囊癌更易发生于老年女性。男女发病率之比为1.0:2.1，平均发病年龄为63.7±11.3岁，农民的发病率高于其他职业群体。（3）共有57.2%（1360/2379）的胆囊癌患者合并胆结石。（4）腹痛（1796/2379，75.5%）和黄疸（727/2379，30.6%）是最常见的临床表现，接受B超检查的患者中81.2%（1527/1881）呈阳性，接受计算机断层扫描的患者中90.7%（1567/1727）呈阳性，64.5%（1124/1742）的胆囊癌患者糖类抗原（CA）19-9呈阳性。（5）胆囊癌的病理类型主要为中低分化腺癌，恶性程度高。在有TNM分期信息的患者中，入院时55.1%（1091/1981）的患者为IV期癌症；55.9%（1331/2379）有淋巴转移，29.7%（706/2379）有胆管转移，53.1%（1263/2379）有肝转移。（6）共有283例患者（283/2379，11.9%）为意外发现的胆囊癌。（7）根治性手术切除率为30.4%（723/2379）。
2009年至2013年中国西北地区胆囊癌在胆道疾病中的比例显著高于1986年至1998年。胆囊癌在老年女性中常见，主要在晚期诊断。与其他不同地区的调查相比，本调查中的转移率较高，导致切除率较低。高危人群应定期接受B超检查，以提高胆囊癌的早期诊断率。
