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Objective To study the impact factors on prognosis of patients with gallbladder adenocarcinoma after surgery.Methods The clinicopathological data of 1 285 patients who underwent surgery and were histologically confirmed to have gallbladder adenocarcinoma from 2004 to 2014 was extracted from the SEER database of US National Cancer Institute.Life table was used to calculate the survival rate.Kaplan-Meier was used to construct the survival curves.Univariate and Cox multivariate regression analysis were applied to evaluate the prognostic factors.The univariate analysis was evaluated by the log-rank x2 test.Results The median survival of 1 285 patients with gallbladder adenocarcinoma was 32 months.The 1-,3-and 5-year survival rates were 77.5％,46.8％ and 36.5％,respectively.The 5-year survival rates of stage Ⅰ,Ⅱ,ⅢA,ⅢB,ⅣA,ⅣB were 72.7％,63.2％,24.6％,20.5％,0 and 5.1％,respectively.The median survival of stage ⅢA,ⅢB,ⅣA and ⅣB were 22 months,19 months,12 months and 16 months,respectively.The differences were statistically significant (P ＜ O.05).Univariate analysis showed that sex,age,degree of differentiation,tumor size,T staging,N staging,number of lymph nodes detected,lymph node metastasis rate,location of lymph node metastasis,and American Joint Commission on cancer (AJCC) staging were significantly associated with prognosis (P ＜ 0.05).There was no significant differences among race and marital status with prognosis (P ＞ 0.05).Multivariate Cox regression analysis showed that sex (male),age (≥ 65 years),degree of differentiation,T staging,number of lymph nodes detected (＜ 4)and AJCC staging were independent risk factors affecting prognosis of patients with gallbladder adenocarcinoma (P ＜ 0.05).Conclusions With increase in AJCC staging,the survival rates in patients with gallbladder adenocarcinoma after surgery decreased gradually.Parameters including sex,age,T staging,number of lymph nodes detected and AJCC staging were independent factors affecting prognosis of patients with gallbladder adenocarcinoma after surgery.
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Objective To study the component ratios of pancreatic carcinoma,and prognosis of patients with the different pathological types.Methods The data of 92 011 pancreatic carcinoma patients who were diagnosed by the definite pathological method from 2004 to 2014 were extracted from the US SEER database.The life table was used to calculate the 1-,3-and 5-year survival rates.The Kaplan-Meier was used to construct the survival curves of the patients.The Cox univariate analysis was applied to evaluate the HR of the different pathological types,and the x2 test and independent sample t-test were used to evaluate the base line data.Results The overall 5-year survival of 92 011 pancreatic carcinoma patients was 7.6％.The median survival time was 8.8 months and the component ratios of the pancreatic ductal adenocarcinoma (PDAC),pancreatic epithelium cancer bedside the PDAC,neuroendocrine tumors,undifferentiated carcinoma,mesenchymal carcinoma and rare cancer unclassified were 85.78％,6.40％,6.67％,0.97％,0.10％ and 0.08％,respectively.The differences were statistically significant between the baseline data such as age,gender,race and position (P ＜ 0.05).The overall 5-year survivals of the PDAC,pancreaticepithelium cancer beside the PDAC,neuroendocrine tumors,undifferentiated carcinoma,mesenchymal carcinoma and rare cancer unclassified were 4.2％,13.4％,49.2％,5.0％,29.2％ and 24.5％,respectively,and the median survival times were 5 months,7 months,58 months,2 months,26 months and 7 months respectively.The distant metastasis rate of neuroendocrine carcinoma was the lowest (35.0％).The undifferentiated carcinoma was the most prone to distant metastases (65.2％).Basically,half of the other types of pancreatic cancer had metastasis at the time of diagnosis.In pancreatic epithelium cancer beside the PDAC,the high to low 5-year survival rates were solid pseudopapillary carcinoma (87.3％),cystadenocarcinoma (36.8％),intraductal papillary mucinous neoplasm (36.5％),acinar cell carcinoma (20.0％),and pancreatic adenocarcinoma mixed with other subtypes (19.7％).The incidence of the other types of pancreatic carcinoma was less than 8％,such as mucinous carcinoma,squamous cell carcinoma,adenosquamous carcinoma and signet ring cell carcinoma.In neuroendocrine tumor,the 5-year survival rate of insulinoma (77.1％) was higher than those of neuroendocrine tumor (malignant) (NET,62.0％) and neuroendocrine carcinoma (NEC,46.5％).Conclusion The prognosis of pancreatic carcinoma was poor,and the pathological types had a significant impact on the prognosis of the patients.
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Objective To study the survival of patients with pancreatic head carcinoma undergoing surgery,and to evaluate the clinicopathological factors associated with prognosis.Methods The data of 4 814 patients who underwent surgery for pancreatic head carcinoma from 2004 to 2009 were extracted from the US SEER database.The life table was used to calculate the survival rate at 5-years.The Kaplan-meier method was used to construct the survival curves of the patients.The univariate and Cox multivariate regression analysis were applied to evaluate the prognostic factors.and the univariate analysis was evaluated by the log-rank x2 test.Results The overall 5-year survival of 4 818 pancreatic head carcinoma patients was 16.3％.The median survival was 18.9 months,and the 5-year survival rates of the stage Ⅰ A,Ⅰ B,Ⅱ A,Ⅱ B,Ⅲ and Ⅳ patients were 38.8％,35.3％,21.8％,12.2％,9.1％,and 7.3％,respectively.The difference was statistically significant (x2 =287.702;P ＜ 0.05).The factors including sex,age,years of diagnosis,pathological grading,tumor size,extent of invasion,lymph node metastasis,distant metastasis,and pathological pattern (all P ＜ 0.05) influenced the survival rate on univariate analysis.There was no clear correlation between race,number of lymph node examined and prognosis.The factors including sex,age,years of diagnosis,pathological grading,tumor size (AJCC 8th),range,extent of invasion,lymph node metastasis,distant metastasis,and pathological pattern (all P ＜ 0.05) were independent prognostic factors on multivariate analysis.Conclusions With the increase of TNM staging,the overall survival of patients with pancreatic head carcinoma undergoing surgery gradually decreased.Factors including sex,age,years of diagnosis,pathological grading,tumor size,extent of invasion,lymph node metastasis,distant metastasis,and pathological pattern were independent prognostic factors of overall survival.
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Objective To investigate the incidence of occult pancreatobiliary reflux and to evaluate its relation to gallbladder epithelial dysplasia and cancer. Methods From July 2006 to Feb 2008,956 cases underwent selective biliary procedure or preoperative endoscopic retrograde cholangiopanereatography (ERCP), bile was collected and amylase was measured. All removed gallbladders were pathologically examined for dysplasia and cancer. Results Occult pancreatobihary reflux was found in 75 of 754 patients in this study, with an incidence of 9. 9%. The biliary amylase values in the patients with occult pancreatobiliary reflux and in controls were 7701±20 378 IU/L and 16±51 IU/L, respectively ( P <0. 01 ).Gallbladder dysplasia and cancer were found in 31.0% and 3.4% of the patients with occult pancreatobiliaryreflux, respectively, and both were higher than those in the patients without pancreatobiliary reflux ( P <0. 05). In the patients with occult pancreatobiliary reflux, the biliary amylase level with gallbladder dysplasia or cancer was 2388 ± 2745 IU/L and was higher than those without gallbladder dysplasia or cancer (P < 0. 01 ). Conclusions With an incidence of 9.9% in patients of normal pancreatobiliary junction,the occult pancreatobihary reflux may contribute to the pathogenesis of gallbladder epithelial dysplasia and cancer.
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Objective To explore how to improve the curative effects and reduce the complications of duodenoscopy in the treatment of bile duct diseases. Methods Clinical data of 292 cases of endoscopic sphincterotomy (EST) and 104 cases of endoscopic nose biliary drainage (ENBD, including 9 post-EST cases) from February 1995 to February 2003 were retrospectively reviewed. Results The success rate of EST was 92.1% (269/292). Among 272 cases of common bile duct calculus, stones were completely taken out in 235 cases (86.4%). Among 15 cases of intrahepatic duct calculus, stones were completely removed in 4 cases. Biliary duct foreign bodies were removed at once in 3 out of 5 cases. EST related complications were found in 16 cases (7 cases of acute pancreatitis, 5 cases of bleeding at the site of incision, 2 cases of severe cholangitis, 1 case of duodenal perforation and 1 case of instrumental break-off), with an incidence rate of 5.5% (16/292). Satisfactory outcomes were achieved in 92 cases receiving ENBD. No death occurred in the study. Conclusions Proper selection of patients and skillful performance of EST is the key to improve its curative effects and reduce its complications.