胆囊癌根治术后复发因素分析及放疗靶区指导

目的:探讨胆囊癌根治术后复发因素及复发模式,为术后辅助放疗靶区提供依据。方法:回顾性分析复旦大学附属中山医院2008—2018年收治的102例胆囊癌并接受根治术患者病例资料,明确复发因素及复发模式(包括瘤床/腹腔淋巴结复发)。其中术后辅助化疗37例,未化疗65例。结果:根治术后中位区域复发时间为12.4个月。单因素分析显示,pT、pN、黏液成分、分化与区域复发相关(P0.05)。pT、pN、分化与瘤床复发相关(P0.05);pT、pN、神经脉管侵犯与腹腔淋巴结复发相关(P0.05)。多因素分析显示,pT、pN是胆囊癌根治术后区域复发的独立预测因子(P0.05)。中位瘤床复发时间为12.5个月(95%CI 8.4～16.5个月)。中位腹腔淋巴结复发时间为10.9个月(95%CI 8.1～13.7个月)。pT/pN是瘤床复发和腹腔淋巴结复发的独立预测因子(P0.05)。术后腹腔淋巴结复发分布:8、12a、16b1高复发(40%);9、12p、13、16a2次之(20%～30%);3、5、6、7、14、16b2、17、18组较少(10%)。结论:胆囊癌根治术后复发率高,pT/pN是影响复发独立因素。即使D1淋巴结清扫,腹腔淋巴结复发仍多见。建议放疗靶区包括瘤床及部分腹腔淋巴结(8、9、12a、12p、13、16a2、16b1)。

Prognostic factors of locoregional failure of gallbladder cancer after radical resection: guidance for adjuvant radiotherapy

Objective: To explore prognostic factors and recurrence patterns in patients with gallbladder cancer after radical surgery,guiding for delineation of clinical target volumethe of postoperative adjuvant radiotherapy.Methods: 102 patients are from Zhongshan Hospital, Fudan University,with gallbladder cancer who underwent radical surgery between 2008 to 2018. Locoregional failure was defined as tumor bed recurrence or celiac lymph node recurrence.102 cases were included in the criteria and fully followed up.37 cases received postoperative adjuvant chemotherapy and 65 did not receive chemotherapy.Results: The mean time of locoregional recurrence was 12.4 months after radical surgery.Univariate analysis:stage pT,stage pN,mucinous adenocarcinoma,tumor differentiation are related to locoregional recurrence(P<0.05). Multivariate analysis:pT and pN are independent predictors(P<0.05).The mean time of tumor bed recurrence was 12.5 months (95% CI 8.4-16.5).The mean time of celiac lymph node recurrence was 10.9 months (95% CI 8.1-13.7).Univariate analysis:pT, pN,tumor differentiation are related to tumor bed recurrence(P<0.05); pT,pN,neurovascular invasion are related to celiac lymph node recurrence (P<0.05).Multivariate analysis:pT/pN are independent predictors of tumor bed recurrence and celiac lymph node recurrence (P<0.05).Recurrence map of abdominal lymph nodes:group 8,12a,16b1 are high risk of recurrence (>40%);group 9,12p,13,16a2 are intermediate risk of recurrence(20%-30%); group 3, 5, 6, 7, 14, 16b2, 17, 18 are fewer recurrent (<10%).Conclusions: The locoregional failure rate of gallbladder cancer after radical resection is high.pT/pN are independent predictors affecting recurrence.Even after n1 site dissection,celiac lymph nodes recurrence is still more often.Clinical target volume of adjuvant radiotherapy can include tumor beds and some celiac lymph nodes:group 8,9,12a,12p,13,16a2,16b1.