Renard P, Boutron M C, Faivre J, Milan C, Bedenne L, Hillon P, Klepping C
Registre des Tumeurs Digestives, Faculté de Médecine, Dijon, France.
J Epidemiol Community Health. 1987 Dec;41(4):344-8. doi: 10.1136/jech.41.4.344.
The registry of digestive tract tumours established for the department of Cote-d'Or (France) was used to study the epidemiological characteristics and the natural history of biliary tract cancers. Age standardised incidence rates for gallbladder cancers were 2.7/100,000 for women and 0.9/100,000 for men. The corresponding rates for extrahepatic bile duct cancers were 0.5/100,000 and 1.7/100,000, and for ampulla of Vater cancer 0.3/100,000 and 0.3/100,000. The three cancers differ in their descriptive epidemiology and should be considered separately in epidemiological analytical investigations. The incidence of each of the three diseases increased with age, and cancers of known histological type were mainly adenocarcinomas. Some gallbladder cancers were undifferentiated or squamous cell carcinomas. There was no significant variation in incidence for gallbladder cancer and extrahepatic bile duct cancer over the eight years of the study. The association with gallstones was frequent in gallbladder cancer: 70.5% compared to 13.0% in other biliary tract cancers (less than 0.001). Although the association of gallbladder cancer with gallstones is frequent, few patients with cholelithiasis experience development of a gallbladder cancer. It is necessary to identify among patients with gallstones a subgroup at high risk of gallbladder cancer in whom prophylactic surgery might be justified. Biliary tract cancers are seldom diagnosed early: lymph nodes or visceral metastases were present in 77% of gallbladder cancers, in 83% of extrahepatic bile duct cancers, and in 55% of ampulla of Vater cancers at the time of diagnosis. The corresponding resectability rates were 46.1%, 11.9%, and 38.9%. The five-year overall survival rates were 2.9% for gallbladder cancer, 0% for extrahepatic bile duct cancer, and 18.3% for ampulla of Vater cancer. The corresponding five-year survival rates after surgery for cure were 10.3%, 0%, and 35.7%. Biliary tract cancer still represent a great therapeutic challenge.
利用为法国科多尔省建立的消化道肿瘤登记系统来研究胆道癌的流行病学特征和自然病史。胆囊癌的年龄标准化发病率女性为2.7/10万，男性为0.9/10万。肝外胆管癌的相应发病率分别为0.5/10万和1.7/10万， Vater壶腹癌为0.3/10万和0.3/10万。这三种癌症在描述性流行病学方面存在差异，在流行病学分析研究中应分别考虑。这三种疾病的发病率均随年龄增长而升高，已知组织学类型的癌症主要为腺癌。一些胆囊癌为未分化癌或鳞状细胞癌。在研究的八年中，胆囊癌和肝外胆管癌的发病率没有显著变化。胆囊癌与胆结石的关联很常见：70.5%，而其他胆道癌为13.0%（P<0.001）。虽然胆囊癌与胆结石的关联很常见，但很少有胆石症患者会发生胆囊癌。有必要在胆结石患者中识别出胆囊癌高危亚组，对其进行预防性手术可能是合理可行的。胆道癌很少能早期诊断：诊断时，77%的胆囊癌、83%的肝外胆管癌和55%的Vater壶腹癌已有淋巴结或内脏转移。相应的可切除率分别为46.1%、11.9%和38.9%。胆囊癌、肝外胆管癌和Vater壶腹癌的五年总生存率分别为2.9%、0%和l8.3%。相应的根治性手术后五年生存率分别为10.3%、0%和35.7%。胆道癌仍然是一个巨大的治疗挑战。
