胆囊癌淋巴结转移的危险因素分析

  目的  探讨胆囊癌患者淋巴结转移的危险因素，为胆囊癌的综合治疗及预后评估提供参考。  方法  收集2013年1月1日至2020年9月30日昆明医科大学第二附属医院行胆囊癌根治术且术后病理检查证实为胆囊腺癌患者的临床及病理资料，将患者分为有淋巴结转移组和无淋巴结转移组，通过单因素和多因素分析确定胆囊癌淋巴结转移的相关危险因素。   结果  最终共纳入101例患者，淋巴结转移组有41例，无淋巴结转移组有60例，单因素分析结果表明T分期、组织学分级、肝脏侵犯、术前CA19-9≥100 U/mL、术前CA19-9+CEA+CA125联合与胆囊腺癌淋巴结转移，差异具有统计学意义（P < 0.05）。二元Logistic回归多因素分析结果表明T分期、组织学分级、术前CA19-9+CEA+CA125联合是胆囊腺癌淋巴结转移的独立危险因素（P < 0.05）。  结论  术前CA19-9≥100 U/mL 或CEA≥20 ng/mL 或CA125≥50 U/mL的胆囊腺癌患者应考虑扩大淋巴结清扫范围，对于T3、T4分期，组织分级为G3、G4，以及术前CA19-9≥100 U/mL 或CEA≥20 ng/mL 或CA125≥50 U/mL的胆囊腺癌患者应考虑术后综合治疗并密切随访。

Analysis of Risk Factors for Lymph Node Metastasis of Gallbladder Cancer

  Objective  To explore the risk factors of lymph node metastasis in patients with gallbladder cancer, and to provide references for comprehensive treatment and prognosis evaluation of gallbladder cancer.   Methods  We retrospectively analyzed the clinical and pathological data of patients with gallbladder cancer confirmed by postoperative pathological examination who underwent radical resection of gallbladder cancer in the Second Affiliated Hospital of Kunming Medical University from January 1, 2013 to September 30, 2020. The patients were divided into Lymph node metastasis group and non-lymph node metastasis group, univariate and multivariate analysis was used to determine the relevant risk factors of gallbladder cancer lymph node metastasis.   Results  A total of 101 patients were finally included, of which 41 patients had lymph node metastasis and 60 patients had no lymph node metastasis. The univariate analysis showed that T stage, histological grade, liver invasion, preoperative CA19-9≥100 U/mL and preoperative CA19-9+CEA+CA125 combination were risk factors for lymph node metastasis of gallbladder adenocarcinoma（P < 0.05）. The results of multivariate analysis showed that T stage, histological grade, and preoperative CA19-9+CEA+CA125 combination were independent risk factors for lymph node metastasis of gallbladder adenocarcinoma（P < 0.05）.  Conclusions   Patients with gallbladder adenocarcinoma with CA19-9≥100 U/mL or CEA≥20 ng/mL or CA125≥50 U/mL should consider expanding the scope of lymph node dissection. For patients with gallbladder adenocarcinoma with T3-T4 staging, histological grade G3-G4 and preoperative CA19-9≥100 U/mL or CEA≥20 ng/mL or CA125≥50 U/mL, comprehensive postoperative treatment and close follow up should be considered.