Gallbladder Cancer (GBC): 10-Year Experience at Memorial Sloan-Kettering Cancer Centre (MSKCC)
Gallbladder Cancer (GBC): 10-Year Experience at Memorial Sloan-Kettering Cancer Centre (MSKCC)
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DOI：
10.1002/jso.21141
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发表时间：
2008-12-01
影响因子：
2.5
通讯作者：
O'Reilly, E. M.
中科院分区：
文献类型：
--
作者：
Duffy, A.;Capanu, M.;O'Reilly, E. M.
背景：美国胆囊癌（GBC）的发病率为1.2/100，000。本报告探讨了一个大的队列GBC患者在MSKCC评估超过10 years period.Methods：回顾性分析的患者被称为MSKCC与GBC诊断1995年1月至2005年12月之间的模式，辅助治疗和生存。从MSKCC癌症登记处确定患者。提取的信息包括人口统计学、临床和病理分期、手术管理、病理学、辅助和姑息治疗、复发日期、死亡或末次随访。诊断日期定义为手术或活检日期。生存曲线估计使用Kaplan-Meier方法和比较使用log-rank test.Results：435例GBC的情况下，确定：285（65.5%）女性，150（34.5%）男性。中位年龄67岁（范围29-100岁）。病理：腺癌88%，鳞状细胞癌4%，神经内分泌癌3%，肉瘤2%。36.6%为AJCC IV期。47%是在腹腔镜胆囊切除术中偶然发现的。其中136例进行了再探索，其中100例（73.5%）有残留病变。在接受根治性切除术的患者中（N=123），8例（6.5%）接受了辅助化疗，8例（6.5%）仅接受了放化疗，8例（6.5%）同时接受了放化疗和全身化疗。队列的中位总生存期为10.3个月（95% CI，中位随访时间为26.6个月）。Ia-III期疾病患者的中位生存期为12.9个月（95% CI 11.7-15.8个月），IV期疾病患者的中位生存期为5.8个月（95% CI 4.5-6.7）。在腹腔镜胆囊切除术中偶然发现的患者的中位生存期为15.7个月（95%CI 12.4-18.4）。对于接受再探查的患者，如果存在残留疾病，中位生存期为14.6个月（95% CI 12.6-18.3），如果没有疾病证据，中位生存期为72个月（95% CI 34至无穷大）。接受辅助治疗者的中位生存期为23.4个月（95%CI 15.7-47）。再次探查显示残留病变的发生率很高（74%）。再次探查时无疾病证据的患者的中位生存期（72个月）优于检测到残留疾病的患者（P < 0.0001）。总体预后较差。虽然我们没有观察到接受辅助治疗的患者的生存益处，但该研究没有足够的能力来解决这个问题。此外，接受辅助治疗的患者数量较少，在临床和治疗细节方面存在显著异质性，因此无法得出任何明确的结论。在这种疾病的辅助治疗的前瞻性随机试验是必要的。
Background: The incidence of gallbladder cancer (GBC) in the US is 1.2/100,000. This report examines the patterns of presentation, adjuvant treatment and survival of a large cohort of patients with GBC evaluated at MSKCC over a 10-year period.Methods: A retrospective analysis of patients referred to MSKCC with a diagnosis of GBC between January 1995 and December 2005 was performed. Patients were identified from the MSKCC cancer registry. Information extracted included, demographics, clinical and pathological stage, surgical management, pathology, adjuvant and palliative therapy, date of relapse, death or last follow-up. Date of diagnosis was defined as date of surgery or biopsy. Survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test.Results: Four hundred thirty-five GBC cases were identified: 285 (65.5%) females,150 (34.5%) males. Median age 67 years (range 29-100). Pathology: 88% adenocarcinoma, 4% squamous, 3% neuroendocrine, 2% sarcoma. 36.6% presented as AJCC Stage IV. 47% were discovered incidentally at laparoscopic cholecystectomy. One hundred thirty-six of these were re-explored, of whom 100 (73.5%) had residual disease. Of those who underwent Curative resections (N=123), 8 (6.5%) received adjuvant chemotherapy, 8 (6.5%) chemoradiation alone and 8 (6.5%) both chemoradiation and systemic chemotherapy. Median Overall Survival for the cohort was 10.3 months (95% CI with a median follow up of 26.6 months. The median survival for those presenting with stage Ia-III disease was 12.9 months (95% CI 11.7-15.8 months) and 5.8 months (95% CI 4.5-6.7) for those presenting with stage IV disease. Median survival was 15.7 months (95% CI 12.4-18.4) for those discovered incidentally at laparoscopic cholecystectomy. For those who underwent re-exploration, median survival was 14.6 months (95% CI 12.6-18.3) if residual disease was present, and 72 months (95% CI34 to infinity) if no evidence of disease. The median survival for those who received adjuvant therapy was 23.4 months (95% CI 15.7-47).Conclusions: GBC is commonly diagnosed incidentally (47%). Re-exploration reveals a high incidence of residual disease (74%). Median survival is better for patients who have no evidence of disease on re-exploration (72 months) compared to those with residual disease detected (P < 0.0001). Overall prognosis is poor. Although we did not observe a Survival benefit for those who received adjuvant therapy, the Study did not have sufficient power to address this question. In addition, the number of patients who received adjuvant therapy was small with marked heterogeneity in clinical and therapeutic details, precluding any definitive conclusions being drawn. Prospective randomized trials of adjuvant therapy are needed in this disease.