摘要
目的探讨2010—2017年中国胆囊癌临床流行病学特征、诊断、治疗与预后情况。方法采用单病种回顾性登记队列研究方法。基于“真实世界研究”理念,收集2010年1月至2017年12月中国胆囊癌研究小组(CRGGC)建立的中国胆囊癌多中心回顾性临床资料数据库中42家医院收治的6159例胆囊癌患者的临床病理资料。观察指标:(1)病例来源情况。(2)年龄与性别分布情况。(3)诊断情况。(4)外科治疗与预后情况。(5)综合治疗与预后情况。随访数据由CRGGC对各协作中心的临床随访数据进行收集整理,主要结局指标为手术治疗患者手术之日或未手术患者确诊之日起,至结局事件发生或随访截至时间的总体生存时间。正态分布的计量资料以x±s表示,组间比较采用t检验;偏态分布的计量资料以M(Q1,Q3)或M(范围)表示,组间比较采用U检验。计数资料以绝对数和(或)百分比表示,组间比较采用χ^(2)检验。单因素分析采用强迫引入Logistic回归模型,将P<0.1的因素引入多因素分析。多因素分析采用逐步后退Logistic回归模型。采用寿命表法计算生存率,采用Kaplan-Meier法绘制生存曲线,采用Log-rank检验进行生存分析。结果(1)病例来源情况:42家医院中,三级甲等医院35家,三级乙等医院7家;胆囊癌收治高流量医院16家,非高流量医院26家。42家医院地域分布:中部地区9家,东北地区5家,东部地区22家,西部地区6家。6159例患者地域分布:2154例(34.973%)来自中部地区,705例(11.447%)来自东北地区,1969例(31.969%)来自东部地区,1331例(21.611%)来自西部地区。6159例患者总体院均诊断与治疗数为(18.3±4.5)例/年;其中4974例(80.760%)来源于高流量医院,院均诊断与治疗患者数为(38.8±8.9)例/年;1185例(19.240%)来源于非高流量医院,院均诊断与治疗患者数为(5.7±1.9)例/年。(2)年龄与性别分布情况:6159例患者确诊年龄为64(56,71)岁;其中男性2247例(36.483%),确诊年龄为64(58,71)岁;女性3912例(63.517%),确诊年龄为63(55,71)岁。性别比例为女性:男性=1.74∶1。3886例(63.095%)患者确诊年龄为56~75岁。不同性别患者确诊年龄比较,差异有统计学意义(Z=-3.99,P<0.001)。(3)诊断情况:6159例患者中,初步诊断为胆囊癌2503例(40.640%),初步诊断非胆囊癌3656例(59.360%)。未手术患者2110例(34.259%),其中初步诊断为胆囊癌200例(9.479%),初步诊断为非胆囊癌1910例(90.521%)。手术患者4049例(65.741%),其中初步诊断为胆囊癌2303例(56.878%),初步诊断为非胆囊癌1746例(43.122%)[术中诊断为胆囊癌774例(19.116%)、术后诊断为胆囊癌972例(24.006%)]。6159例患者中,初步诊断前行超声、CT、磁共振成像(MRI)检查分别为2521例(40.932%)、2335例(37.912%)、1114例(18.087%),行血清癌胚抗原(CEA)、CA19-9、CA125检测分别为3259例(52.914%)、3172例(51.502%)、4016例(65.205%)。同一例患者可行多种检查。单因素分析结果显示:来源医院地区(东部地区、西部地区),年龄(≥72岁),收治医院胆囊癌患者流量,初步诊断前超声检查,初步诊断前CT检查,初步诊断前MRI检查,初步诊断前CEA检测,初步诊断前血清CA19-9检测,初步诊断前血清CA125检测均是影响胆囊癌患者初步诊断为胆囊癌的相关因素(优势比=1.45、1.98,0.69,0.68,2.43,0.41,1.63,0.41,0.39,0.42,95%可信区间为1.21~1.74、1.64~2.40,0.59~0.80,0.60~0.78,2.19~2.70,0.37~0.45,1.43~1.86,0.37~0.45,0.35~0.43,0.38~0.47,P<0.05)。多因素分析结果显示:来源医院地区(东部地区、西部地区),性别,年龄(≥72岁),收治医院胆囊癌患者流量,初步诊断前超声检查,初步诊断前CT检查,初步诊断前血清CA19-9检测是影响胆囊癌患者初步诊断为胆囊癌的独立影响因素(优势比=1.36、1.42,0.89,0.67,1.85,1.56,1.57,0.39,95%可信区间为1.13~1.64、1.16~1.73,0.79~0.99,0.57~0.78,1.60~2.14,1.38~1.77,1.38~1.79,0.35~0.43,P<0.05)。(4)外科治疗与预后情况:4049例手术治疗患者中,2447例(60.435%)分期资料和随访资料完整,0期、Ⅰ期、Ⅱ期、Ⅲa期、Ⅲb期、Ⅳa期、Ⅳb期分别为85例(3.474%)、201例(8.214%)、71例(2.902%)、890例(36.371%)、382例(15.611%)、33例(1.348%)、785例(32.080%)。2447例患者中位随访时间为55.75个月(95%可信区间为52.78~58.35),术后总体中位生存时间为23.46个月(95%可信区间为21.23~25.71)。0期、Ⅰ期、Ⅱ期、Ⅲa期、Ⅲb期、Ⅳa期、Ⅳb期患者总体生存情况比较,差异有统计学意义(χ^(2)=512.47,P<0.001)。4049例手术治疗患者中,可切除性肿瘤2988例(73.796%),不可切除性肿瘤177例(4.371%),可切除性无法评估884例(21.833%)。2988例可切除性肿瘤患者中,根治性切除2036例(68.139%),非根治性切除504例(16.867%),手术根治性无法评估448例(14.994%)。2447例分期和随访资料完整的手术治疗患者中,不可切除性肿瘤53例(2.166%),可切除性肿瘤非根治性切除300例(12.260%),可切除性肿瘤根治性切除1441例(58.888%),无法评估653例(26.686%)。733例未手术患者随访资料完整。未手术、不可切除性肿瘤手术治疗、可切除性肿瘤非根治性切除、可切除性肿瘤根治性切除患者总体生存情况比较,差异有统计学意义(χ^(2)=121.04,P<0.001)。(5)综合治疗与预后情况:6159例患者中,541例(8.784%)行术后辅助化疗和晚期化疗,76例(1.234%)行放疗。1170例进展期(Ⅲa期及以上)行根治性切除手术患者中,联合术后辅助化疗126例(10.769%),未联合术后辅助化疗1044例(89.231%),两者总体生存情况比较,差异无统计学意义(χ^(2)=0.23,P=0.629)。658例Ⅲa期行根治性切除手术患者中,联合术后辅助化疗66例(10.030%),未联合术后辅助化疗592例(89.970%),两者总体生存情况比较,差异无统计学意义(χ^(2)=0.05,P=0.817)。512例≥Ⅲb期行根治性切除手术患者中,联合术后辅助化疗60例(11.719%),未联合术后辅助化疗452例(88.281%),两者总体生存情况比较,差异无统计学意义(χ^(2)=1.50,P=0.220)。结论我国胆囊癌患者女性多于男性,超过半数确诊年龄为56~75岁。初步诊断前行超声和CT检查、血清CA19-9检测是初步诊断胆囊癌的独立影响因素,基于术前可切除性评估可改进治疗决策、改善患者预后。我国胆囊癌辅助化疗尚不规范且比例较低。
Objective To investigate the epidemiological characteristics,diagnosis,treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods The single disease retrospective registration cohort study was conducted.Based on the concept of the real world study,the clinicopathological data,from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer(CRGGC),of 6159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected.Observation indicators:(1)case resources;(2)age and sex distribution;(3)diagnosis;(4)surgical treatment and prognosis;(5)multimodality therapy and prognosis.The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC.The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up.Measurement data with normal distribu-tion were represented as Mean±SD,and comparison between groups was conducted using the t test.Measurement data with skewed distribution were represented as M(Q1,Q3)or M(range),and com-parison between groups was conducted using the U test.Count data were described as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test.Univariate analysis was performed using the Logistic forced regression model,and variables with P<0.1 in the univariate analysis were included for multivariate analysis.Multivariate analysis was performed using the Logistic stepwise regression model.The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves.Log-rank test was used for survival analysis.Results(1)Case resources:of the 42 hospitals,there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals,16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer,respectively.Geographical distribution of the 42 hospitals:there were 9 hospitals in central China,5 hospitals in northeast China,22 hospitals in eastern China and 6 hospitals in western China.Geographical distribution of the 6159 patients:there were 2154 cases(34.973%)from central China,705 cases(11.447%)from northeast China,1969 cases(31.969%)from eastern China and 1331 cases(21.611%)from western China.The total average number of cases undergoing diagnosis and treatment in hospitals of the 6159 patients was 18.3±4.5 per year,in which the average number of cases undergoing diagnosis and treatment in hospitals of 4974 patients(80.760%)from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1185 patients(19.240%)from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year.(2)Age and sex distribution:the age of 6159 patients diagnosed as gallbladder cancer was 64(56,71)years,in which the age of 2247 male patients(36.483%)diagnosed as gallbladder cancer was 64(58,71)years and the age of 3912 female patients(63.517%)diagnosed as gallbladder cancer was 63(55,71)years.The sex ratio of female to male was 1.74:1.Of 6159 patients,3886 cases(63.095%)were diagnosed as gallbladder cancer at 56 to 75 years old.There was a significant difference on age at diagnosis between male and female patients(Z=-3.99,P<0.001).(3)Diagnosis:of 6159 patients,2503 cases(40.640%)were initially diagnosed as gallbladder cancer and 3656 cases(59.360%)were initially diagnosed as non-gallbladder cancer.There were 2110 patients(34.259%)not undergoing surgical treatment,of which 200 cases(9.479%)were initially diagnosed as gallbladder cancer and 1910 cases(90.521%)were initially diagnosed as non-gallbladder cancer.There were 4049 patients(65.741%)undergoing surgical treatment,of which 2303 cases(56.878%)were initially diagnosed as gallbladder cancer and 1746 cases(43.122%)were initial diagnosed as non-gallbladder cancer.Of the 1746 patients who were initially diagnosed as non-gallbladder cancer,there were 774 cases(19.116%)diagnosed as gallbladder cancer during operation and 972 cases(24.006%)diagnosed as gallbladder cancer after operation.Of 6159 patients,there were 2521 cases(40.932%),2335 cases(37.912%)and 1114 cases(18.087%)undergoing ultrasound,computed tomography(CT)or magnetic resonance imaging(MRI)examination before initial diagnosis,respec-tively,and there were 3259 cases(52.914%),3172 cases(51.502%)and 4016 cases(65.205%)undergoing serum carcinoembryonic antigen,CA19-9 or CA125 examination before initially diagnosis,respectively.One patient may underwent multiple examinations.Results of univariate analysis showed that geographical distribution of hospitals(eastern China or western China),age≥72 years,gallbladder cancer annual admission of hospitals,whether undergoing ultrasound,CT,MRI,serum carcinoembryonic antigen,CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients(odds ratio=1.45,1.98,0.69,0.68,2.43,0.41,1.63,0.41,0.39,0.42,95%confidence interval as 1.21-1.74,1.64-2.40,0.59-0.80,0.60-0.78,2.19-2.70,0.37-0.45,1.43-1.86,0.37-0.45,0.35-0.43,0.38-0.47,P<0.05).Results of multivariate analysis showed that geographical distribution of hospitals(eastern China or western China),sex,age≥72 years,gallbladder cancer annual admission of hospitals and cases undergoing ultrasound,CT,serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients(odds ratio=1.36,1.42,0.89,0.67,1.85,1.56,1.57,0.39,95%confidence interval as 1.13-1.64,1.16-1.73,0.79-0.99,0.57-0.78,1.60-2.14,1.38-1.77,1.38-1.79,0.35-0.43,P<0.05).(4)Surgical treatment and prognosis.Of the 4049 patients undergoing surgical treatment,there were 2447 cases(60.435%)with complete pathological staging data and follow-up data.Cases with pathological staging as stage 0,stageⅠ,stageⅡ,stageⅢa,stageⅢb,stageⅣa and stageⅣb were 85(3.474%),201(8.214%),71(2.902%),890(36.371%),382(15.611%),33(1.348%)and 785(32.080%),respectively.The median follow-up time and median postoperative overall survival time of the 2447 cases were 55.75 months(95%confidence interval as 52.78-58.35)and 23.46 months(95%confidence interval as 21.23-25.71),respectively.There was a significant difference in the overall survival between cases with pathological staging as stage 0,stageⅠ,stageⅡ,stageⅢa,stageⅢb,stageⅣa and stageⅣb(χ^(2)=512.47,P<0.001).Of the 4049 patients undergoing surgical treatment,there were 2988 cases(73.796%)with resectable tumor,177 cases(4.371%)with unresectable tumor and 884 cases(21.833%)with tumor unassessable for resectabi-lity.Of the 2988 cases with resectable tumor,there were 2036 cases(68.139%)undergoing radical resection,504 cases(16.867%)undergoing non-radical resection and 448 cases(14.994%)with operation unassessable for curative effect.Of the 2447 cases with complete pathological staging data and follow-up data who underwent surgical treatment,there were 53 cases(2.166%)with unresectable tumor,300 cases(12.260%)with resectable tumor and receiving non-radical resection,1441 cases(58.888%)with resectable tumor and receiving radical resection,653 cases(26.686%)with resectable tumor and receiving operation unassessable for curative effect.There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data.There was a significant difference in the overall survival between cases not undergoing surgical treatment,cases undergoing surgical treatment for unresectable tumor,cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor(χ^(2)=121.04,P<0.001).(5)Multimodality therapy and prognosis:of 6159 patients,there were 541 cases(8.784%)under-going postoperative adjuvant chemotherapy and advanced chemotherapy,76 cases(1.234%)under-going radiotherapy.There were 1170 advanced gallbladder cancer(pathological staging≥stageⅢa)patients undergoing radical resection,including 126 cases(10.769%)with post-operative adjuvant chemotherapy and 1044 cases(89.231%)without postoperative adjuvant chemo-therapy.There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy(χ^(2)=0.23,P=0.629).There were 658 patients with pathological staging as stageⅢa who underwent radical resection,including 66 cases(10.030%)with postoperative adjuvant chemotherapy and 592 cases(89.970%)without postoperative adjuvant chemotherapy.There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy(χ^(2)=0.05,P=0.817).There were 512 patients with pathological staging≥stageⅢb who underwent radical resection,including 60 cases(11.719%)with postoperative adjuvant chemotherapy and 452 cases(88.281%)without postoperative adjuvant chemotherapy.There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy(χ^(2)=1.50,P=0.220).Conclusions There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years.Cases undergoing ultrasound,CT,serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients.Preoperative resectability evaluation can improve the therapy strategy and patient prognosis.Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.
作者
孙旭恒
王一钧
张薇
耿亚军
李永盛
任泰
李茂岚
王许安
吴向嵩
吴文广
陈炜
陈涛
何敏
王辉
杨林华
邹路
蒲鹏
杨明杰
刘照南
陶雯琦
冯佳毅
贾子衡
郑志元
钟丽静
钱源滢
董平
王雪峰
顾钧
刘连新
钱叶本
顾剑峰
柳咏
崔云甫
孙备
李兵
邵成浩
姜小清
马强
郑进方
刘昌军
曹宏
陈晓亮
李其云
王琳
王昆华
张磊
郑林辉
朱春富
蔡鸿宇
曹景玉
朱海宏
刘军
党学义
刘建生
张学利
徐军明
费哲为
杨晓平
杨佳华
张再洋
王旭林
王益
郝继辉
张启瑜
金慧涵
刘昌
韩玮
闫军
武步强
戴朝六
吕文才
全志伟
彭淑牖
龚伟
刘颖斌
Sun Xuheng;Wang Yijun;Zhang Wei;Geng Yajun;Li Yongsheng;Ren Tai;Li Maolan;Wang Xu'an;Wu Xiangsong;Wu Wenguang;Chen Wei;Chen Tao;He Min;Wang Hui;Yang Linhua;Zou Lu;Pu Peng;Yang Mingjie;Liu Zhaonan;Tao Wenqi;Feng Jiayi;Jia Ziheng;Zheng Zhiyuan;Zhong Lijing;Qian Yuanying;Dong Ping;Wang Xuefeng;Gu Jun;Liu Lianxin;Qian Yeben;Gu Jianfeng;Liu Yong;Cui Yunfu;Sun Bei;Li Bing;Shao Chenghao;Jiang Xiaoqing;Ma Qiang;Zheng Jinfang;Liu Changjun;Cao Hong;Chen Xiaoliang;Li Qiyun;Wang Lin;Wang Kunhua;Zhang Lei;Zheng Linhui;Zhu Chunfu;Cai Hongyu;Cao Jingyu;Zhu Haihong;Liu Jun;Dang Xueyi;Liu Jiansheng;Zhang Xueli;Xu Junming;Fei Zhewei;Yang Xiaoping;Yang Jiahua;Zhang Zaiyang;Wang Xulin;Wang Yi;Hao Jihui;Zhang Qiyu;Jin Huihan;Liu Chang;Han Wei;Yan Jun;Wu Buqiang;Dai Chaoliu;Lyu Wencai;Quan Zhiwei;Peng Shuyou;Gong Wei;Liu Yingbin(Department of Pancreatobiliary Surgery,Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai Cancer Institute,State Key Laboratory for Oncogenes and Related Genes,Shanghai Key Laboratory of Biliary Tract Disease Research,Shanghai 200127,China;Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine,Shanghai 200092,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Univer-sity of Science and Technology of China,Anhui Provincial Hospital,Hefei 230001,China;Department of Hepato-Biliary-Pancreatic Surgery,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of General Surgery,Changshu No.1 People's Hospital,Changshu 215500,Jiangsu Province,China;Department of Oncology,Changzhou Hospital of Traditional Chinese Medicine,Changzhou 213003,Jiangsu Province,China;Department of Pancreatobiliary Surgery,the Second Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Hepato-Biliary-Pancreatic Surgery,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Hepato-Biliary-Pancreatic Surgery,Harbin Medical University Cancer Hospital,Harbin 150081,China;The Fourth Department of General Surgery,the Second Affiliated Hospital of Naval Medical University,Shanghai Changzheng Hospital,Shanghai 200003,China;The First Department of Biliary Surgery,Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University,Shanghai 200438,China;Department of Hepatic Surgery,Hainan General Hospital,Haikou 570311,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Hu'nan Normal University,People's Hospital of Hu'nan Province,Changsha 410000,China;Department of Hepatobiliary Surgery,Xinmin District of China-Japan Union Hospital of Jilin University,Changchun 130499,China;Depart-ment of Hepatobiliary Surgery,People's Hospital of Jaingxi Province,Nanchang 330006,China;Department of Abdominal Surgical Oncology,Jiangxi Cancer Hospital,Nanchang 330029,China;Department of Hepato-Biliary-Pancreatic and Spleen Surgery,Xijing Hospital Affiliated to Air Force Medical University,Xi'an 710032,China;Department of Gastrointestinal Surgery,the First Affiliated Hospital of Kunming Medical University,Kunming 650032,China;The Fifth Department of General Surgery,the First Hospital of Lanzhou University,Lanzhou 730020,China;Department of Emergency,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Hepato-Biliary-Pancreatic Surgery,Changzhou No.2 People's Hospital Affiliated to Nanjing Medical University,Changzhou 213004,Jiangsu Province,China;Department of Hepatobiliary Surgery,Nantong Tumor Hospital,Nantong 226361,Jiangsu Province,China;Department of Hepato-Biliary-Pancreatic Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of General Surgery,Qinghai Provincial People's Hospital,Xining 810007,China;Department of Organ Transplantation and Second Department of Hepatobiliary Surgery,Provincial Hospital Affiliated to Shandong First Medical University,Shandong Provincial Hospital,Ji'nan 250021,China;The First Department of General Surgery,Shanxi Provincial Cancer Hospital,Taiyuan 030009,China;Department of General Surgery,the First Affiliated Hospital of Shanxi Medical University,Taiyuan 030001,China;Department of General Surgery,South Hospital of the Sixth People's Hospital Affiliated to Shanghai Jiaotong Univer-sity,Shanghai Fengxian District Central Hospital,Shanghai 201499,China;Department of General Surgery,Shanghai General Hospital Affiliated to Shanghai Jiaotong University,Shanghai 200080,China;Department of General Surgery,Xinhua(Chongming)Hospital Affiliated to Shanghai JiaoTong University School of Medicine,Shanghai 200092,China;Department of General Surgery,Shanghai Pudong Hospital,Shanghai 201399,China;Department of General Surgery,Putuo Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200062,China;Department of General Medicine,Shaoxing Second Hospital,Shaoxing 312099,Zhejiang Province,China;Department of Hepatobiliary Surgery,Taizhou Municipal Hospital,Taizhou 318000,Zhejiang Province,China;Department of Gastrointestinal Surgery,the First People's Hospital of Taicang,Taicang 215413,Jiangsu Province,China;Department of Pancreatic Oncology,Tianjin Medical University Cancer Institute and Hospital,Tianjin 300181,China;Department of Hepato-Biliary-Pancreatic Surgery,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,Zhejiang Province,China;Department of Hepatobiliary Surgery,Wuxi Second People's Hospital,Wuxi 214002,Jiangsu Province,China;Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Pancreatic Surgery,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830054,China;Department of Hepato-Biliary-Pancreatic and Spleen Surgery,Xuzhou Central Hospital,Xuzhou 221009,Jiangsu Province,China;Department of Hepato-biliary Surgery,Heping Hospital Affiliated to Changzhi Medical College,Changzhi 046099,Shanxi Province,China;Department of Hepatobiliary and Spleen Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Hepatobiliary Surgery,Dalian Friendship Hospital Affiliated to Dalian Medical University,Dalian 116100,Liaoning Province,China;Department of Hepato-Biliary-Pancreatic Surgery,the Second Affiliated Hospital of Zhejiang University School of medicine,Hangzhou 310009,China)
出处
《中华消化外科杂志》
CAS
CSCD
北大核心
2022年第1期114-128,共15页
Chinese Journal of Digestive Surgery
基金
国家自然科学基金(3213000192,81874181,2019XH004)
上海市科委项目(YDZX20193100004049,20JC1419101)
重大新药创制科技重大专项(2019ZX09301-158)
申康新兴前沿项目(SHDC12018107)
上海交通大学医学院多中心临床研究项目(DLY201507,15ZH4003)。
关键词
胆道肿瘤
术前诊断
外科治疗
辅助治疗
流行病学
影响因素
预后
Biliary tract neoplasms
Preoperative diagnosis
Surgical treatment
Adju-vant treatment
Epidemiology
Influencing factor
Prognosis
