Ren T, Li Y S, Geng Y J, Li M L, Wu X S, Wu W W, Wang X A, Shu Y J, Bao R F, Dong P, Gong W, Gu J, Wang X F, Lu J H, Mu J S, Pan W H, Zhang X, Zhang X L, Fei Z W, Zhang Z Y, Wang Y, Cao H, Sun B, Cui Y F, Zhu C F, Li B, Zheng L H, Qian Y B, Liu J, Dang X Y, Liu C, Peng S Y, Quan Z W, Liu Y B
Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China.
Zhonghua Wai Ke Za Zhi. 2020 Sep 1;58(9):697-706. doi: 10.3760/cma.j.cn112139-20200403-00279.
To evaluate the clinical characteristics and prognosis of gallbladder cancer (GBC) patients in China. 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. 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%. 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.
评估中国胆囊癌（GBC）患者的临床特征及预后。这项回顾性多中心队列研究纳入了2010年1月至2017年12月期间在10个省份的15家医院连续诊断的3528例GBC患者。其中男性1345例（38.12%），女性2183例（61.88%）。诊断时的年龄为（63.7±10.8）岁（范围：26至99岁）。0至Ⅰ期患者213例（6.04%），Ⅱ至Ⅲ期1059例（30.02%），Ⅳ期1874例（53.12%），分期不明者382例（10.83%）。2255例患者（63.92%）接受了手术。336例患者接受了化疗或放疗（9.52%；其中172例为姑息性治疗）；1101例（31.21%）仅接受了支持性治疗。分析了患者来源、治疗与手术、病理、合并胆结石情况及预后。在3528例GBC患者中，华东地区959例（27.18%），东北1区603例（17.09%），华中地区1533例（43.45%），西部地区433例（12.27%）。在1578例可切除肿瘤患者中，665例（42.14%）接受了根治性手术，913例（57.86%）接受的手术未遵循指南。891例（56.46%）患者在手术前确诊，254例（16.10%）在手术中确诊，381例（24.14%）在手术后确诊（52例患者诊断时间点无法确定）。在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%）切缘阳性，510例（76.7%）切缘阴性，86例（12.9%）未报告切缘情况。3528例患者队列的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期接受姑息性手术患者的5yOS为4.7%。中国半数以上的GBC患者在Ⅳ期确诊。根治性手术对改善可切除GBC患者的预后有价值。GBC的治疗需要进一步规范。迫切需要有效的GBC综合治疗。
