Prognostic factors in the surgical treatment of gallbladder carcinoma.
Prognostic factors in the surgical treatment of gallbladder carcinoma.
复制标题
胆囊癌手术治疗的预后因素。
作者：
K. Ouchi;Y. Owada;S. Matsuno;T. Sato
对 36 名能够耐受根治性切除的原发性胆囊癌患者进行了临床和病理学检查。肿瘤暴露于浆膜层的患者(n = 17)的5年生存率显着低于肿瘤局限于粘膜层(n = 7)、肌层(n = 7)或浆膜下层(n = 5)的患者。从宏观上看，所有仅限于粘膜的肿瘤和仅限于肌层的 7 个肿瘤中的 6 个均为乳头状肿瘤，与渗透至浆膜的 17 个肿瘤中的 11 个肿瘤中的结节状或浸润性肿瘤相比，乳头状肿瘤患者的生存率更高（p 小于 0.05）。乳头状或分化良好的癌（存在于所有胆囊浆膜下浅表肿瘤患者中）的生存率（p 小于 0.001 和 p 小于 0.01）高于 17 例扩散到浆膜的肿瘤中的 7 例中存在的中度或低分化癌。扩散到浆膜外的肿瘤的静脉、淋巴管或神经周围侵犯的发生率高于局限于粘膜的肿瘤（p 小于 0.05），并且具有和不具有这些特征的患者之间的生存率存在差异（p 小于 0.001）。对那些局限于粘膜的肿瘤的核DNA模式的分析揭示了其较低的细胞恶性程度。浆膜下浅表肿瘤患者在接受扩大胆囊切除术后比接受单纯胆囊切除术的患者存活时间更长（p 小于 0.05）。胆囊癌的预后不仅受到肿瘤的生物学性质的高度影响，而且还受到所采用的外科手术的影响。
A clinical and pathologic review was undertaken of 36 patients with primary carcinoma of the gallbladder who could tolerate curative resection. The 5-year survival rate of the patients with tumor exposed to the serosa (n = 17) was significantly lower than that of the patients with tumor limited to the mucosa (n = 7), muscularis (n = 7), or subserosa (n = 5). Macroscopically, all tumors limited to the mucosa and 6 of 7 limited to the muscularis were of the papillary form, which was associated with a better patient survival (p less than 0.05) than the nodular or infiltrative form present in 11 of 17 tumors that penetrated to the serosa. The papillary or well-differentiated carcinoma--present in all patients with tumors superficial to the gallbladder subserosa--had a higher survival (p less than 0.001 and p less than 0.01) than the moderately or poorly differentiated carcinoma present in 7 of 17 tumors with spread to the serosa. Incidences of venous, lymphatic, or perineural invasion were higher in tumors that spread beyond the serosa than those limited to the mucosa (p less than 0.05), and survival differed between patients with and without these characteristics (p less than 0.001). Analysis for nuclear DNA pattern of those tumors limited to the mucosa revealed its lower cellular malignancy. Patients with tumors superficial to the subserosa survived longer after undergoing extended cholecystectomy than those who underwent simple cholecystectomy (p less than 0.05). The prognosis of gallbladder carcinoma was highly influenced not only by the biologic nature of tumor but by the surgical procedures used.