Prognostic heterogeneity of the seventh edition of UICC Stage III gallbladder carcinoma: Which patients benefit from surgical resection?
Prognostic heterogeneity of the seventh edition of UICC Stage III gallbladder carcinoma: Which patients benefit from surgical resection?
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DOI：
10.1016/j.ejso.2017.01.001
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发表时间：
2017-04-01
期刊：
影响因子：
3.8
通讯作者：
Wakai, T.
中科院分区：
文献类型：
--
作者：
Sakata, J.;Kobayashi, T.;Wakai, T.
背景：本研究旨在评估国际抗癌联盟第七版分期中Ⅲ期胆囊癌的预后异质性。
方法：在175例接受根治性切除的胆囊癌患者中，22例为ⅢA期（T3N0M0），46例为ⅢB期（T2N1M0［n = 23］和T3N1M0［n = 23］）。每位患者平均获取的淋巴结数量为18个。
结果：该分期系统未能区分ⅢA期和ⅢB期的预后情况；ⅢB期患者切除后的生存率优于ⅢA期患者，5年生存率分别为54.9%和41.0%（p = 0.366）。对Ⅲ期患者的多因素分析显示，T2N1M0患者的生存率独立优于T3N0M0（p = 0.016）或T3N1M0（p = 0.001）患者，5年生存率分别为77.0%、41.0%和31.0%。当根据阳性淋巴结数量对N1状态进行细分时，T2M0且有1 - 2个阳性淋巴结、T2M0且有≥3个阳性淋巴结、T3M0且有1 - 2个阳性淋巴结以及T3M0且有≥3个阳性淋巴结的患者5年生存率分别为83.3%、50.0%、45.8%和0%（p < 0.001）。
结论：T2N1M0疾病的预后优于T3N0/1M0疾病，这表明并非所有淋巴结阳性的胆囊癌患者在切除术后都会有一致的不良预后。T2M0且有1 - 2个阳性淋巴结的患者在切除术后预后良好，而T3M0且有≥3个阳性淋巴结则预示着预后不良。（C）2017爱思唯尔有限公司，英国外科肿瘤协会以及欧洲肿瘤外科学会。版权所有。
Background: This study sought to evaluate the prognostic heterogeneity of Stage III (Union for International Cancer Control, seventh edition) gallbladder carcinoma.Methods: Of 175 patients enrolled with gallbladder carcinoma who underwent radical resection, 22 were classified with Stage IIIA disease (T3N0M0) and 46 with Stage IIIB disease (T2N1M0 [n = 23] and T3N1M0 [n = 23]). The median number of retrieved lymph nodes per patient was 18.Results: This staging system failed to stratify outcomes between Stages IIIA and IIIM; survival after resection was better for patients with Stage In disease than for patients with Stage IIIA disease, with 5-year survival of 54.9% and 41.0%, respectively (p = 0.366). Multivariate analysis for patients with Stage III disease revealed independently better survival for patients with T2N1M0 than for patients with T3N0M0 (p = 0.016) or T3N1M0 (p = 0.001), with 5-year survival of 77.0%, 41.0%, and 31.0%, respectively. When N1 status was subdivided according to the number of positive nodes, 5-year survival in patients with T2M0 with 1-2 positive nodes, T2M0 with >= 3 positive nodes, T3M0 with 1-2 positive nodes, and T3M0 with >= 3 positive nodes was 83.3%, 50.0%, 45.8%, and 0%, respectively (p < 0.001).Conclusions: The prognosis of T2N1M0 disease was better than that of T3N0/1M0 disease, suggesting that not all node-positive patients will have uniformly poor outcomes after resection of gallbladder carcinoma. T2M0 with 1-2 positive nodes leads to a favorable outcome after resection, whereas T3M0 with >= 3 positive nodes indicates a dismal prognosis. (C) 2017 Elsevier Ltd, BASO - The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.