| Purpose :Using the clinical data of 1145 patients with gallbladder cancer to establish a line map of the prognosis of patients and verify it;analyze the application value of tumor markers in the diagnosis of gallbladder cancer;to investigate the effect of different treatment measures on the prognosis of patients with gallbladder cancer;and to investigate the diagnosis and treatment status of 188 patients with accidental gallbladder cancer.Methods :(1)Using a case-control retrospective study.The data of 1145 clinicopathological patients with gallbladder cancer treated in our hospital from2012.1.1 to 2019.1.1 were collected.Follow up by outpatient or telephone to understand the survival of patients after operation.Follow-up time as of June 2019.Cox proportional risk regression models screen independent risk factors affecting prognosis.Line charts are drawn in the language of The R Project for Statistical Computing,Vienna,Austria val package and rms package implementation,and the variable score is calculated using the nomogramex package.The accuracy of the line diagram is judged by the C-index and the correction curve.Internal verification is completed by repeated sampling 1000 times by Bootstrap method,and external verification is verified by verification set.In this study,compared with the predictive ability of AJCC staging,the rcorp.cens function of R language was used.(2)The source was 250 patients with gallbladder cancer,polyps of gallbladder and gallstone who were treated in our hospital from January 1,2012 to January 2,2019.CA199,CEA,CA125,and CA242 tests and pathological diagnosis were performed respectively.The diagnosis included gallbladder polyps,gallstones and gallbladder cancer.Among them,112 cases of gallstone or gallbladder polyp,138 cases of gallbladder cancer.the sensitivity,specificity,positive predictive value and negative predictive value of each tumor marker were investigated.(3)There were 749 patients with surgical records,including laparoscopic gallbladder resection(LC or Caesarean section),total cholecystectomy(radical 1),hepatic hilar dissection of IVb V segment of gallbladder bed(radical 2),extended radical resection(radical 3),short-circuit surgery and palliative resection,percutaneous hepatic drainage(PTCD,etc.).to investigate the effect of surgical modalities on prognosis.(4)Select the patients with accidental gallbladder cancer who were treated in our hospital from2012.1.1 to 2019.1.1.Among them,138 were female,50 were male and 1:2.76 were male and the age distribution was 40～83 years,the median age was 61 Age.To investigate the clinical data of 188 patients with accidental gallbladder cancer.Results:(1)The clinical data of 1145 patients showed that the prognosis of patients of independent risk factors affecting with gallbladder cancer included: male,age >79,middle/low differentiation degree,presence of lymph node metastasis,paracancerous invasion and distant metastasis(P<0.05),the risk was 1.237,1.551,2.969,1.957,1.492 and 1.446 and so on.(2)The C-index of internal validation was 0.76(95% CI0.74-0.78),and the DSS correction curve of 5 years after operation indicated good agreement between the observed value and the predicted value;the C-index of AJCC stage was 0.70(95% CI 0.67-0.73).(3)The median DSS survival of the validation set was 25.14 months,and the DSS-associated survival rate of 1,3,5 years after operation was 71.0%,38.7%,30.5%.the external validation c-index was 0.73(95% ci 0.68 –0.78).taking the 5-year survival rate as an example,the external validation showed good consistency with the training set.(4)The positive rate of CA199 and CEA in the observation group was statistically significant(P <0.05),and the positive rate of CA242 and CA125 was not statistically significant(P >0.05).The positive rate of CA199 in the observation group was significantly higher than that in the control group,and the positive rate of CEA was significantly lower than that in the control group.(5)CA199 has the highest sensitivity for the diagnosis of gallbladder cancer,reaching 48.55%;CA199 has the highest specificity,reaching 99.11%,and its positive predictive value can reach 98.53%.(6)Patients in the observation group and the control group were statistically significant in CA242+CEA,CA199+CEA,CA199+CA125,CEA+CA125,etc(P<0.05).The CA242+CEA positive rate,CA199+CEA positive rate and CEA+CA125 positive rate in the control group were significantly higher than those in the observation group,and the CA199+CA125 positive rate in the observation group was significantly higher than that in the control group.(7)The sensitivity of CA242+CA199 and CA199+CA125 can exceed50%,53.75% and 51.72%,respectively,when both tumor markers are used in thediagnosis of gallbladder cancer.At the same time,the specificity of CA199+CA125 was 76.39%,and the positive and negative predicted values could reach 63.83% and66.27%,respectively.(8)The difference between the observation group and the control group was statistically significant in CA242+CA199+CEA,CA199+CEA+CA125,etc.(P<0.05).The CA242+CA199+CEA positive rate and CA199+CEA+CA125 positive rate in the control group were significantly higher than those in the observation group.(9)The sensitivity of CA242+CA199+CEA and CA199+CEA12 was over 50%,reaching 59.49% and 52.63% when the three tumor markers were used in the diagnosis of gallbladder cancer.However,the indexes of specificity,positive predictive value and negative predictive value were all poor.(10)There were 221 patients with LC or C-section,accounting for 29.51% of all patients,accounting for the largest proportion,while patients with advanced gallbladder cancer had a small proportion of palliative or short-circuit surgery and PTCD surgery,respectively 20% and 14.69%.(11)The patients were divided into cholecystectomy group,radical cure group 1,radical cure group 2 and radical cure group 3 according to different operation methods,and the clinical data of four groups were significantly different in sex,accidental gallbladder cancer,biliary comorbidity,TNM stage(P<0.05).There was no significant difference between the remaining clinical data(P >0.05).(12)There were significant differences in survival time(P <0.05),the specific manifestations were that the prognosis of radical 2 and cholecystectomy was significantly better than that of patients with radical 1 and radical 3.1-year survival rate,3-year survival rate,5-year survival rate showed the same trend,gallbladder The prognosis of resectomized and curative 2 was significantly better than that of curative1 and curative 3 patients(P <0.05).(13)Of the 188 patients with accidental gallbladder cancer,181 had a complete prognostic survival time record with a survival time distribution of 1.93 to 85.41 months(the median survival time was 38.8 months).The patient’s 1-year survival rate was 91.71%(166/181),the 3-year survival rate was54.70%(99/181)and the 5-year survival rate was 21.55%(39/181).Conclusion :(1)sex,age,degree of differentiation,lymph node metastasis,invasion range,metastasis,etc.,are independent risk factors affecting the prognosis of patients with gallbladder cancer.The line diagram based on the above factors canpredict the disease-related survival rate of patients with gallbladder cancer more accurately and intuitively.(2)The sensitivity of CA199+CA125 is the best way to diagnose gallbladder cancer.(3)The proportion of cholecystectomy performed by LC or Caesarean section was the largest,while the proportion of palliative or short-circuit surgery and PTCD surgery performed by patients with advanced gallbladder cancer was relatively small.Clinical data on different surgical procedures There are differences in unexpected gallbladder cancer,biliary complications,TNM staging and so on.the postoperative survival and survival rate of radical 2 and cholecystectomy were significantly better than those of patients with radical 1 and radical 3.(4)The incidence of accidental gallbladder cancer is increasing year by year with the number of laparoscopic cholecystectomy in middle-aged and elderly women;(5)preventive cholecystectomy is recommended for single stones with diameters exceeding 3cm,multiple stones,gallstones,gallstones,congenital abnormalities at the confluence of the gallbladder and pancreatic duct,calcification of the gallbladder mucosa and symptomatic gallbladder polyps or asymptomatic polyps with diameter between 5mm and 10mm;(6)For early gallbladder cancer,there was no significant difference in survival between patients with simple cholecystectomy and radical cholecystectomy as long as R0 resection was achieved. |
PDF Full Text Request