Is Carcinoma of the Gallbladder a Curable Lesion?
Is Carcinoma of the Gallbladder a Curable Lesion?
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胆囊癌是可以治愈的病变吗？
DOI：
10.1097/00000658-198205000-00012
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发表时间：
1982
影响因子：
9
通讯作者：
R. Fechner
中科院分区：
文献类型：
--
作者：
H. Wanebo;W. N. Castle;R. Fechner
胆囊癌是一种罕见但并非罕见的肿瘤，切除后五年生存率为 5%，但在过去几十年中，大多数系列中该生存率并未明显改善。然而，Nevin 等人20报道，分期良好的胆囊癌（根据组织学分级和浸润深度）具有相对良好的预后。他们引用 66 名患者的总体五年生存率为 21%。大多数幸存患者 (11) 属于有利的分期类别：I 期（粘膜内癌）和 II 期（粘膜和肌层浸润）。其余少数处于 III 期（侵袭所有层）、IV 期（囊性淋巴结转移）或 V 期（转移扩展到肝脏或远处部位）。我们对数据进行了分析，以确定原发性癌症的显微分期是否会选出预后良好的亚组，以及根据手术切除的类型是否有生存获益。对 1930 年至 1978 年间在弗吉尼亚大学医院接受治疗的 100 名患者进行了临床和病理学检查。其中有 77 名女性和 23 名男性，平均年龄 65 岁（范围 21-89）。 78% 的患者患有胆结石。手术包括单纯胆囊切除术（23 名患者）、胆囊切除加胆道引流（17 名患者）、胆囊切除术和肝床切除（8 名患者）以及活检或搭桥探查（44 名患者）。仅对八名患者进行了尸检。只有 3 名长期幸存者（6 岁、11 岁和 24 岁）。单纯胆囊切除术的中位生存期为 6 个月，胆囊切除术和搭桥术的中位生存期为 5 个月，部分肝切除术后的中位生存期为 14 个月，剖腹手术/搭桥术/活检后的中位生存期为 2.0 个月。单独胆囊切除术或搭桥术后的五年生存率为 5%，胆囊切除术和部分肝脏切除术后的五年生存率为 13% (1/8) (p = 0.07)。原发性癌症的显微分期显示没有预后良好的亚组。在 46 名具有微分期病变的患者中，只有 13% 属于非常有利的 I 期和 II 期组（六分之一存活），46% 属于 III 期（1/21 存活），其余 41% 属于非常不利的 IV 期和 V 期组（1/19 存活）。大多数患者表现出原发性或继发性局部区域（肝脏和淋巴结）疾病进展。尽管对于有利的早期癌症，单独进行胆囊切除术可能会带来长期生存，但这仍然不常见。尽管尚未得到证实，理论上对所选患者进行肝床切除和区域淋巴结清扫可能具有价值，并可能辅以辅助治疗。未来需要化学疗法和放射疗法的进步来提高这种疾病目前较差的治愈率。
Carcinoma of the gallbladder is an uncommon, but not rare tumor that is associated with a 5% five-year survival rate after resection and this rate has not appreciably improved over the last decades in most series. Nevin et al.20 however have reported that favorably staged gallbladder cancers (according to histologic grade and depth of invasion) have a relatively good prognosis. They quoted an overall five-year survival of 21% in 66 patients. Most of the surviving patients (11) were in the favorably staged category: Stage I (intramucosal cancer) and Stage II (invasion of mucosa and muscularis). The remaining few were in Stage III (invasion of all layers), Stage IV (cystic node metastases), or Stage V (extension of metastases to the liver or distant sites). Our data has been analyzed to determine whether microstaging of the primary cancer will select out a subgroup with a favorable prognosis, and whether there are survival benefits according to the type of surgical resection. A clinical and pathologic review was done of 100 patients treated at the University of Virginia Hospital from 1930 to 1978. There were 77 women and 23 men, with an average age of 65 years (range 21–89). Gallstones were described in 78% of the patients. Surgical procedures included cholecystectomy alone (23 patients), cholecystectomy with biliary drainage (17 patients), cholecystectomy and resection of the hepatic bed (8 patients), and exploration with biopsy or bypass (44 patients). Autopsy only was done in eight patients. There were only three long-term survivors (6 years, 11 years, and 24 years). Median survival was six months with cholecystectomy alone, five months with cholecystectomy and bypass, 14 months after partial liver resection, and 2.0 months after laparotomy/bypass/biopsy. The five-year survival rate was 5% after cholecystectomy alone or with bypass, and 13% (1/8) after cholecystectomy and partial liver resection (p = 0.07). Microstaging of the primary cancers showed no prognostically favorable subgroup. Of 46 patients with microstaged lesions, only 13% were in the very favorable Stage I and II groups (only one of six survived), 46% were Stage III (1/21 survived), and the remaining 41% were in the highly unfavorable Stage IV and V groups (1/19 survived). Most patients showed progression of disease either primarily or secondarily that was locoregional (liver and nodes). Although long-term survival may accompany cholecystectomy alone for a favorable early-staged cancer, this is still uncommon. There may be theoretical, although not proven, merit for resection of the hepatic bed and regional node dissection in the selected patient, possibly complimented by adjuvant therapy. Future advances in chemotherapy and radiation will be needed to augment the current poor cure rate of this disease.