基于SEER数据库分析手术在Ⅳ期胆囊癌治疗中的作用

目的 探究手术对Ⅳ期胆囊癌患者预后的影响。方法 从美国SEER数据库筛选2010年1月1日至2015年12月31日间诊断的4 627例Ⅳ期胆囊癌患者,根据是否进行手术治疗分为手术组（3 535例）和非手术组（1 092例）。倾向得分匹配后共得到1 344例,其中手术组和未手术组各672例。采用Cox风险回归模型分析Ⅳ期胆囊癌患者预后的独立风险因素,通过Kaplan-Meier法进行总体和各亚组生存分析和亚组分析,绘制生存曲线并计算中位生存时间（median survival time,MST）。结果 Cox回归模型提示原发灶部位、肿瘤分级、N分期、M分期、放疗、化疗、婚姻状况和手术（HR 0.590,95%CI 0.517~0.672,P<0.001）是Ⅳ期胆囊癌患者预后的独立危险因素。手术组中位（四分位间距）生存时间长于未手术组7（14）个月 vs 3（8）个月,P<0.001],1年31.6% vs 16.3%,P<0.001]、3年9.4% vs 1.4%,P<0.001]生存率均高于未手术组,差异均有统计学意义。亚组分析显示,对于所有原发灶部位、M分期、放疗情况、化疗情况的亚组的Ⅳ期胆囊癌,手术均能改善患者的生存时间和生存结局。结论 手术可以改善Ⅳ期胆囊癌患者的预后情况,且是影响预后的独立危险因素之一。

Effect of surgery in treatment of patients with stage Ⅳ gallbladder carcinoma: A SEER data-based analysis

Objective To explore the effect of surgery on the prognosis of patients with stage Ⅳ gallbladder cancer. Methods A total of 4 627 cases with stage Ⅳ gallbladder cancer diagnosed from Jan. 1, 2010 to Dec. 31, 2015 were collected from SEER database and divided into surgery group (n=3 535) and non-surgery group (n=1 092) according to whether they underwent surgery. A total of 1 344 cases were obtained fter propensity score matching, both 672 cases in surgery group and non-surgery group. The independent risk factors for the prognosis of patients with stage Ⅳ gallbladder cancer were analyzed by proportional hazards model. The Kaplan-Meier method was used for survival analysis and subgroup analysis. Survival curves and median survival time (MST) were calculated. Results The proportional hazards model showed that primary site, tumor grade, N stage, M stage, radiotherapy, chemotherapy, marital status and surgery (HR 0.590, 95%CI 0.517-0.672, P<0.001) were independent risk factors for the prognosis of patients with stage Ⅳ gallbladder cancer. Patients in surgery group had longer MST 7(14) months vs 3(8) months, P<0.001], and higher one year 31.6% vs 16.3%, P<0.001] and three years survival rate 9.4% vs 1.4%, P<0.001] than that of the patients in non-surgery group. The subgroup analysis showed that surgery could improve the survival time and survival outcomes of patients with stage Ⅳ gallbladder carcinoma in all subgroups involving primary site, M stage, radiotherapy and chemotherapy. Conclusion Surgery may improve the prognosis of patients with stage Ⅳ gallbladder carcinoma, and is one of the independent risk factors prognosis.