胆囊癌Nevin分期与AJCC分期的临床应用价值比较

目的 比较Nevin、AJCC两种胆囊癌分期方法的临床应用价值. 方法回顾性分析2000年2月至2006年10月手术治疗的胆囊癌患者90例的临床资料,按两种分期方法评估不同分期的术后生存率、肿瘤切除率、切缘阴性率和术式选择情况.计数资料采用X2检验. 结果随Nevin、AJCC分期增加,患者术后生存率、肿瘤切除率、切缘阴性率显著下降(P<0.05).Nevin Ⅲ期、Ⅳ期患者中切除术与根治术的生存率差异无统计学意义(P>0.05),Ⅴ期患者根治术、扩大根治术的生存率显著高于切除术、引流术、活检术者(P<0.05).AJCC Ⅲ期患者中根治术生存率显著高于切除术、引流术、活检术者(P<0.05),Ⅳ期生存率各术式之间差异尤统计学意义(P>0.05).52例AJCCⅢ期、Ⅳ期按Nevin分期均为Ⅴ期,AJCC Ⅲ期生存率显著高于Ⅳ期(P=0.0001),Ⅲ期切除率显著高于Ⅳ期(P=0.001),Ⅲ期行根治性手术者显著高于Ⅳ期(P=0.001),Ⅳ期行引流术、活检术者显著高于Ⅲ期(P=0.001).结论 Nevin分期与AJCC分期均能较好的评估患者预后及手术的可切除性、切缘阴性率、术式选择.AJCC分期对晚期胆囊癌的划分较Nevin分期更科学.

A comparative study on Nevin and AJCC staging system for gallbladder carcinoma

Objective To evaluate the clinical value of Nevin and AJCC staging system for gallbladder carcinoma. Methods In this study 90 patients diagnosed as gallbladder carcinoma underwent operation in Renji Hospital from February 2000 to October 2006. Patients were staged according to Nevin and AJCC staging system. The difference of survival rate, tumor resection rate, ratio of tumor-free resection margin and surgical procedures were analyzed. Results The survival rate, tumor resection rate and ratio of tumor-free resection margin decreased progressively with increasing Nevin and AJCC stage (P < 0. 05). There was no significant difference between the survival rate for Nevin Ⅲ or Ⅳ patients undergoing radical resection and simple cholecystectomy (P > 0. 05). In Nevin Ⅴ patients, the survival rate for radical and extensive radical resection patients was higher than for palliative patients (P < 0. 05). In AJCC Ⅲ patients, the survival rate for radical patients was significant higher than for palliative patients (P < 0. 05). Nosignificant difference was found between radical and palliative patients in survival time in AJCC Ⅳ (P > 0. 05). 52 patients in AJCC Ⅲ and Ⅳ were staged to Nevin Ⅴ according to Nevin staging system. The survival rate and resectable rate for the patients in AJCC Ⅲ were higher than in AJCC Ⅳ (P = 0. 0001, 0. 001 respectively). The rate of radical operation in AJCC Ⅲ was higher (P = 0. 001), and the rate of palliative operation in AJCC Ⅳ was higher (P = 0. 001). Conclusion Both Nevin and AJCC staging system are useful in the judgement of survival, reeectability, ratio of tumor-free resection margin and the optimal operation. AJCC staging system is more applicable for gallbladder carcinoma patients at advanced stage in terms of predicting prognosis.