膽囊癌根治術(shù)后輔助放射治療對患者預(yù)后的影響

鄭州大學(xué)附屬腫瘤醫(yī)院(河南省腫瘤醫(yī)院)肝膽胰外科，河南 鄭州 450008

【Abstract】ObjectiveTo investigate the effects of radiotherapy after radical resection of gallbladder carcinoma.MethodsForty-seven patients with Navin Stage Ⅱ and Ⅲ gallbladder carcinoma admitted to He’nan Cancer Hospital Affiliated to Zhengzhou University from Jan. 2011 to Jan. 2016 were assigned to the group including 28 patients not receiving postoperative adjuvant therapy (NT group), or the group receiving postoperative adjuvant radiotherapy (RT group); overall survival and disease-free survival were compared between two groups.ResultsThere was statistically significant difference in postoperative disease-free survival between two groups (P=0.014); while there was no statistically significant difference in postoperative overall survival between two groups (P=0.118), the median survival was longer in the RT group (18.4 months) than that in the NT group (13.8 months).ConclusionAdjuvant radiotherapy after radical resection has positive effects on the long-term prognosis of patients with Stage Ⅱ and Ⅲ gallbladder carcinoma.

【Keywords】 Gallbladder carcinoma; Radical resection; Radiotherapy; Adjuvant therapy; Overall survival; Disease-free survival

膽囊癌是一種罕見的膽道惡性腫瘤，我國膽囊癌發(fā)病占同期膽道疾病的0.4%～3.8%，5年生存率僅為5%，膽囊癌早期具有難發(fā)現(xiàn)、難診斷、晚期預(yù)后差等特點，手術(shù)是治療膽囊癌的主要方法，早期(R0、Ⅰ、Ⅲ期)的根治性切除對患者遠(yuǎn)期生存有著重要意義，膽囊癌術(shù)后綜合治療對膽囊癌患者預(yù)后有著積極的影響。本文通過搜集河南省腫瘤醫(yī)院2011年1月至2016年1月收治的47例術(shù)后病理確診為膽囊癌并接受膽囊癌根治術(shù)的患者，其中19例接受術(shù)后輔助化療，對比未進(jìn)行術(shù)后輔助放療的28例膽囊癌患者無病生存期及總生存期，旨在探討膽囊癌根治術(shù)后輔助放療對患者長期生存的影響，現(xiàn)報道如下。

1 資料與方法

1.1一般資料選取河南省腫瘤醫(yī)院2011年1月至2016年1月膽囊癌手術(shù)患者76例，男29例(38.15%)，女47例(61.85%)，年齡38～74歲，平均年齡60.3歲，其中47例根據(jù)術(shù)前檢查及術(shù)中探查情況，行膽囊癌根治術(shù)，術(shù)后均經(jīng)病理證實為膽囊癌，并進(jìn)行隨訪。

1.2納入及排除標(biāo)準(zhǔn)納入標(biāo)準(zhǔn)：(1)根據(jù)患者術(shù)前影像學(xué)及術(shù)后病理證實為膽囊癌；(2)患者均處于Navin分期Ⅱ、Ⅲ期；(3)無肝外轉(zhuǎn)移，行膽囊癌根治術(shù)，術(shù)后切緣陰性；(4)術(shù)前患者一般狀況良好，肝功能Child分級A～B級，無合并黃疸、癌栓；(5)無遠(yuǎn)處轉(zhuǎn)移或侵犯重要血管。排除標(biāo)準(zhǔn)：(1)術(shù)前或術(shù)后全身狀況較差，無法承受術(shù)后輔助放療；(2)出現(xiàn)肝外轉(zhuǎn)移；(3)術(shù)后病理提示切緣不凈；(4)Navin分期Ⅱ、Ⅲ期以外的患者。

1.3研究方法選取符合納入標(biāo)準(zhǔn)的47例患者，其中23例行膽……