Simple Cholecystectomy Is Adequate for Patients With T1b Gallbladder Adenocarcinoma < 1 cm in Diameter
Simple Cholecystectomy Is Adequate for Patients With T1b Gallbladder Adenocarcinoma < 1 cm in Diameter
复制标题
对于直径 < 1 厘米的 T1b 胆囊腺癌患者，简单的胆囊切除术就足够了
DOI：
10.3389/fonc.2019.00409
复制
发表时间：
2019-05-22
影响因子：
4.7
通讯作者：
Zhang, Yun
中科院分区：
文献类型：
--
作者：
Wang, Zhengshi;Li, Yao;Zhang, Yun
目的：基于共识的临床指南建议单纯胆囊切除术（SC）足以治疗T1a胆囊腺癌（GBA），但对于T1b及更晚期的GBA应考虑扩展胆囊切除术（EC）， SC加淋巴清扫。T1b GBA的治疗是否需要淋巴清扫仍有争议。本研究试图通过检查淋巴结（LN）转移与肿瘤大小的关系，更好地确定T1b大湾区局部治疗的现行标准。患者和方法：从监测、流行病学和最终结果（SEER）数据库中收集2004年至2015年接受根治性手术治疗的T1b GBA患者的临床数据。描述了整个队列的基线特征，并使用Kaplan-Meier方法分析了总生存期（OS）和癌症特异性生存期（CSS）。结果：共纳入277例患者进行进一步分析；127例行淋巴结切除术。其中23例肿瘤直径< 1 cm，均无淋巴结转移；104例患者肿瘤>= 1 cm，其中15例患者的LNs阳性。在肿瘤大小< 1 cm组中，SC与EC治疗的生存率无显著差异（P = 0.694）。肿瘤大小为>= 1 cm的T1b GBA患者接受EC与接受SC的临床获益（P = 0.012）。结论：SC可有效治疗T1b < 1cm直径的GBA。这一证据可作为现行指南的一部分。
Purpose: Consensus-based clinical guidelines recommend that simple cholecystectomy (SC) is adequate for T1a gallbladder adenocarcinoma (GBA), but extended cholecystectomy (EC), SC plus lymphatic dissection, should be considered for T1b and more advanced GBA. Whether lymphatic dissection is necessary for the treatment of T1b GBA remains controversial. This study attempts to better define the current criteria for local treatment of T1b GBA, by examining the relationship between lymph node (LN) metastasis and tumor size in such patients.Patients and methods: Clinical data from patients with T1b GBA receiving curative surgical treatment between 2004 and 2015 were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Baseline characteristics for the entire cohort were described, and overall survival (OS) and cancer-specific survival (CSS) were analyzed with the Kaplan-Meier method.Results: In total, 277 patients were enrolled for further analysis; 127 underwent lymphadenectomy. Among them, 23 patients had tumors < 1 cm in diameter, none of which had LN metastasis; 104 patients had tumors >= 1 cm, 15 of which had positive LNs. In the group with tumor size < 1 cm, there was no significant survival difference between treatment with SC or EC (P = 0.694). A clinical benefit was observed in T1b GBA patients with a tumor size >= 1 cm receiving EC vs. those receiving SC (P = 0.012).Conclusion: SC was adequate for treatment of T1b GBA < 1 cm in diameter. This evidence may be included as part of current guidelines.