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.Method:1.Collect the clinical and pathological data of patients with gallbladder cancer who underwent radical resection of gallbladder cancer in our hospital from January 1,2013 to September 30,2020 and the postoperative pathological examination confirmed them as gallbladder adenocarcinoma.2.Research content:Analyze the relationship between clinical and pathological data of patients with gallbladder adenocarcinoma and lymph node metastasis.According to the results of lymph node pathological examination,patients with gallbladder adenocarcinoma were divided into two groups:a group with lymph node metastasis and a group without lymph node metastasis.The collected clinical and pathological data include:(1)General clinical data:①Age(divided into two groups of<65 years and≥65 years),②Gender(divided into two groups of male and female),③BMI(divided into two groups of<24 kg/m2 and≥24 kg/m2),④gallbladder stones(divided into two groups:without gallbladder stones and with gallbladder stones),⑤tumor location(divided into the bottom of the gallbladder body and the neck of the gallbladder or the two groups of the cystic duct).(2)Pathological data:①T staging(divided into two groups:T1-T2 and T3-T4),②histological grade(divided into two groups:G1-G2 and G3-G4),③distant metastasis(divided into two groups:no distant metastasis and distant metastasis),④vascular infiltration(divided into two groups:no vascular infiltration and vascular infiltration),⑤extrahepatic bile duct invasion(divided into two groups:no extrahepatic bile duct invasion and extrahepatic bile duct invasion),⑥liver invasion(divided into two groups:no extrahepatic bile duct invasion and extrahepatic bile duct invasion).(3)Laboratory indicators:①preoperative CA19-9(divided into two groups of<100 U/ml and ≥100 U/ml),②preoperative CEA(divided into two groups of<20 ng/ml and≥20 ng/ml),③preoperative CA125(divided into two groups of<50 U/ml and≥50 U/ml),④preoperative CA19-9+CEA+CA125(divided into negative and positive groups,positive group:CA19-9≥100 U/ml or CEA≥20 ng/ml or CA125≥50 U/ml,the tumor in the negative group is less than the above value),⑤Preoperative neutrophil to lymphocyte ratio(divided into two groups<2.76 and≥2.76).3.Statistical Methods:SPSS 21.0 software was used for statistical analysis.Measurement data were represented by χ±S,and counting data were compared by chi-square test.The test standard α=0.05,and P<0.05 was considered statistically significant.The risk factors obtained from univariate analysis were analyzed by Logistic regression model for multivariate analysis to determine independent risk factors.The test standard α=0.05,and P<0.05 was considered statistically significant.Results:1.A total of 815 patients with gallbladder collection,288 patients underwent surgery treatment,of which 149 patients undergoing radical surgery,by incorporating and exclusion standard finalized with 101 patients in the study(T staging include T1-T4,stage and T1b above the gallbladder were lymph node cleaning,pathological diagnosis hint gallbladder adenocarcinoma),In this study,there were 42 male patients and 59 female patients,ranging in age from 34 to 86 years,and the average age was 59.16±10.16 years old,BMI range to 15.6-29 kg/m2.2.Univariate analysis results(1)Gender(χ2=0.710,p=0.399)、age≥65 years(χ2=0.118,P=0.731)、complication of gallstones(χ2=0.131,P=0.718)、BMI≥24 kg/m2(χ2=0.630,P=0.427),tumor site(χ2=0.273,P=0.601)、bile duct invasion(χ2=0.015,P=0.902)、nerve invasion(χ2=1.880,P=0.170)、Preoperative CEA≥20ng/ml(χ2=2.718,P=0.099)、Preoperative CA125>50U/ml(χ2=3.783,P=0.052)and Preoperative neutrophil to lymphocyte ratio≥2.76(χ2=0.032,P=0.859)on lymph node metastasis of gallbladder adenocarcinoma were not statistically significant(P>0.05).(2)T stage(χ2=13.102,P=0.000)、histological grade(χ2=10.771,P=0.001)、distant metastasis(χ2=9.335,P=0.002)、vascular invasion(χ2=6.095,P=0.014)、liver invasion(χ2=4,697,P=0.03)、Preoperative CA19-9≥100 U/ml(χ2=4.572,P=0.033)and Preoperative CA19-9+CEA+CA125 combination(χ2=1.557,P=0.001)on lymph node metastasis of gallbladder adenocarcinoma were statistically significant(P<0.05).3.Multivariate analysis resultsT stage(OR=17.197,P=0.031)、histological grade(OR=3.071,P=0.044)and Preoperative CA19-9+CEA+CA125 combination(OR=11.752,P=0.046)were statistically significant with lymph node metastasis of gallbladder adenocarcinoma in this study(P<0.05).Conclusion:1.T3,T4 staging,histological grades G3,G4,and preoperative CA19-9≥100 U/ml or CEA≥20 ng/ml or CA125≥50 U/ml are independent risk factors for lymphatic metastasis of gallbladder adenocarcinoma.2.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 T3 and T4 staging,the histological grade is G3,G4,and preoperative patients with gallbladder adenocarcinoma with CA19-9≥100 U/ml or CEA≥20 ng/ml or CA125≥50 U/ml should consider postoperative comprehensive treatment and close follow-up.