Lei J J, Zhang J, Chen C, Li Q, Su J B, Zhang D, Zhang R, Jin Z C, Geng Z M
Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China.
Zhonghua Wai Ke Za Zhi. 2022 Jul 1;60(7):695-702. doi: 10.3760/cma.j.cn112139-20220108-00016.
To examine the correlation between perineural invasion and clinicopathological factors and the role of perineural invasion on the prognosis of patients with curatively resected gallbladder carcinoma. The clinicopathological and follow-up data of 548 patients with gallbladder carcinoma who underwent radical surgery from the First Affiliated Hospital of Xi'an Jiaotong University from January 2013 to December 2020 were analyzed retrospectively. There were 173 males and 375 females,with age((IQR)) of 62(14)years(range:30 to 88 years). The correlations between perineural invasion and the clinicopathological features were analyzed. The relationship between prognosis and clinicopathological factors were further analyzed. The survival curve was drawn using the Kaplan-Meier method. The univariate analysis and multivariate analysis were done using the Log-rank test and Cox proportional hazard model respectively. Radical resection was performed in 548 cases,including 59 cases(10.8%) with perineural invasion. The results of univariate analysis showed that perineural invasion was related to serum bilirubin level,serum carcinoembryonic antigen(CEA) level,CA19-9 level,T stage,lymph node metastasis,liver invasion,vessel invasion and tumor location(all <0.05).The results of multivariate analysis showed that jaundice,high-level serum CA19-9,high-level serum CEA,T4 stage,vessel invasion and tumor located in the neck or cystic duct of the gallbladder were independent risk factors of perineural invasion in gallbladder carcinoma. Survival of 367 patients in T3-T4 stages were analyzed. The prognosis of gallbladder carcinoma patients with perineural invasion was significantly worse than that of patients without perineural invasion(median survival time:12.0 months 34.7 months,<0.01). Univariate analysis showed that perineural invasion,gallbladder stones,gallbladder polyps,CA125,CEA,CA19-9,serum bilirubin level,tumor location,N stage,liver invasion and pathological differentiation were independent risk factors affecting prognosis of patients with gallbladder carcinoma(all <0.05). The results of Cox proportional hazard model showed that perineural invasion,N stage,liver invasion,gallbladder stones,pathological differentiation were independent risk factors affecting prognosis of patients with gallbladder carcinoma(all <0.05). Jaundice,high-level serum CA19-9,high-level serum CEA,T4 stage,vessel invasion and tumor located in the neck or cystic duct of the gallbladder are independent risk factors for perineural invasion of gallbladder carcinoma. Perineural invasion is one of the independent risk factors affecting the prognosis of T3-T4 stage gallbladder carcinoma.
探讨胆囊癌根治性切除患者神经周围侵犯与临床病理因素的相关性以及神经周围侵犯对患者预后的作用。回顾性分析2013年1月至2020年12月在西安交通大学第一附属医院接受根治性手术的548例胆囊癌患者的临床病理及随访资料。其中男性173例，女性375例，年龄（四分位间距）为62（14）岁（范围：30至88岁）。分析神经周围侵犯与临床病理特征之间的相关性。进一步分析预后与临床病理因素之间的关系。采用Kaplan-Meier法绘制生存曲线。分别采用Log-rank检验和Cox比例风险模型进行单因素分析和多因素分析。548例患者均行根治性切除，其中神经周围侵犯59例（10.8%）。单因素分析结果显示，神经周围侵犯与血清胆红素水平、血清癌胚抗原（CEA）水平、CA19-9水平、T分期、淋巴结转移、肝脏侵犯、血管侵犯及肿瘤位置均相关（均P<0.05）。多因素分析结果显示，黄疸、血清CA19-9高水平、血清CEA高水平、T4期、血管侵犯及肿瘤位于胆囊颈部或胆囊管是胆囊癌神经周围侵犯的独立危险因素。分析367例T3-T4期患者的生存情况。神经周围侵犯的胆囊癌患者预后明显差于无神经周围侵犯的患者（中位生存时间：12.0个月对34.7个月，P<0.01）。单因素分析显示，神经周围侵犯、胆囊结石、胆囊息肉、CA125、CEA、CA19-9、血清胆红素水平、肿瘤位置、N分期、肝脏侵犯及病理分化是影响胆囊癌患者预后的独立危险因素（均P<0.05）。Cox比例风险模型结果显示，神经周围侵犯、N分期、肝脏侵犯、胆囊结石、病理分化是影响胆囊癌患者预后的独立危险因素（均P<0.05）。黄疸、血清CA19-9高水平、血清CEA高水平、T4期、血管侵犯及肿瘤位于胆囊颈部或胆囊管是胆囊癌神经周围侵犯的独立危险因素。神经周围侵犯是影响T3-T4期胆囊癌预后的独立危险因素之一。
