Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study.
Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study.
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DOI：
10.1097/sla.0000000000000728
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发表时间：
2015-04
影响因子：
9
通讯作者：
Vauthey JN
中科院分区：
文献类型：
--
作者：
Shindoh J;de Aretxabala X;Aloia TA;Roa JC;Roa I;Zimmitti G;Javle M;Conrad C;Maru DM;Aoki T;Vigano L;Ribero D;Kokudo N;Capussotti L;Vauthey JN
探讨胆囊癌肿瘤部位对预后的影响。肿瘤深度是胆囊癌根治性切除术后生存率的强预测因子。然而，胆囊与肝脏有独特的解剖关系，肿瘤位置的临床意义仍不清楚。我们分析了在4个国际机构切除的437例胆囊癌患者的临床病理特征及其与生存率的关系。将肿瘤位置定义为“肝侧”或“腹膜侧”，并评估肿瘤位置的预后意义。在252例T2病变患者中，肝侧肿瘤患者（T2 h，n=99）的血管侵犯、神经侵犯和淋巴结转移率高于腹膜侧肿瘤患者（T2 p，n=153）（分别为51% vs. 19%、33% vs. 8%和40% vs. 17%，均P<0.01）。中位随访58.9个月后，T2 h肿瘤的3年和5年生存率分别为52.1%和42.6%，T2 p肿瘤分别为73.7%和64.7%（P=0.0006）。在T1或T3肿瘤中没有观察到这种差异。多变量分析证实了T2期肿瘤肝侧位置与生存率的独立相关性（风险比，2.7; 95%CI，1.7 - 4.2; P<0.001）。T2肿瘤的这种亚分类预测了即使在根治性切除术后肝脏（23% vs. 3%，P=0.003）和远处淋巴结（16% vs. 3%，P=0.019）的复发。T2期胆囊癌根治性切除术后，肿瘤位置可预测复发和生存模式。
To determine the prognostic impact of tumor location in gallbladder cancer. Depth of tumor is a strong predictor of survival after curative resection of gallbladder cancer. However, the gallbladder has a unique anatomical relationship with the liver, and the clinical significance of tumor location remains unclear. For 437 patients with gallbladder cancer resected at 4 international institutions, clinicopathologic characteristics and their association with survival were analyzed. Tumor location was defined as “hepatic side” or “peritoneal side”, and the prognostic significance of tumor location was evaluated. Among the 252 patients with T2 disease, patients with tumors on the hepatic side (T2h, n=99) had higher rates of vascular invasion, neural invasion, and nodal metastasis than patients with tumors on the peritoneal side (T2p, n=153) (51% vs. 19%, 33% vs. 8%, and 40% vs. 17%, respectively, P<0.01 for all). After a median follow-up of 58.9 months, 3-year and 5-year survival rates were 52.1% and 42.6%, respectively, for T2h tumors and 73.7% and 64.7%, respectively, for T2p tumors (P=0.0006). No such differences were observed in T1 or T3 tumors. Multivariate analysis confirmed the independent association of hepatic-side location with survival in T2 tumors (hazard ratio, 2.7; 95% CI, 1.7 to 4.2; P<0.001). This subclassification of T2 tumors predicted recurrence in the liver (23% vs. 3%, P=0.003) and distant lymph nodes (16% vs. 3%, P=0.019) even after radical resection. After curative resection of T2 gallbladder cancer, tumor location predicts the pattern of recurrence and survival.