Clinical significance of wall invasion pattern of subserosa-invasive gallbladder carcinoma.
Clinical significance of wall invasion pattern of subserosa-invasive gallbladder carcinoma.
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DOI：
10.3892/or.2012.1971
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发表时间：
2012-11
期刊：
影响因子：
4.2
通讯作者：
Makuuchi H
中科院分区：
文献类型：
--
作者：
Okada K;Kijima H;Imaizumi T;Hirabayashi K;Matsuyama M;Yazawa N;Dowaki S;Tobita K;Ohtani Y;Tanaka M;Inokuchi S;Makuuchi H
我们曾将胆囊癌(GBC)的侵袭方式分为浸润性生长型(IG型)和破坏性生长型(DG型)。DG型在组织分化、淋巴侵犯、静脉侵犯、淋巴结状态、神经侵犯和浆膜下侵犯方式等方面与分化差、侵袭性和术后生存率显著相关。在本研究中，我们分析了42例侵犯肌周结缔组织(Pt2)的浆膜下侵袭性胆囊腺癌。5年累计生存率为48.7%。淋巴侵犯(p=0.021)、静脉侵犯(p=0.020)、浆膜下侵犯(p<；0.001)、组织分化(p=0.030)和胆道侵犯(p=0.007)在DG型浸润性较强或分化较差的病例中发生率较高。根治性切除病例的累积5年生存率DG型低于IG型(分别为68.9%和20.2%，p=0.006，log-ranch检验)。在Cox比例风险回归模型中，静脉/神经侵犯程度低和IG型壁侵犯与总生存率的显著改善相关。我们的数据表明，浆膜下侵袭性GBC的壁侵犯类型是一个独立的生存预测因子。根据我们的概念在临床上的应用，根据浆膜下侵袭性胆囊癌患者的壁侵及淋巴结状态，DG型和/或N2型患者(n=21)的总体生存率低于IG型和N0、1转移型患者(n=21)(p=0.0023，log-ranch检验)。浆膜下侵袭性胆囊癌的壁侵及类型可为根治性切除提供参考。
We have previously classified wall invasion patterns of gallbladder carcinoma (GBC) cases into two groups, i.e., the infiltrative growth type (IG type) and destructive growth type (DG type). The DG type was significantly associated with poor differentiation, aggressive infiltration and decreased postoperative survival in terms of its histological differentiation, lymphatic invasion, venous invasion, lymph node status, neural invasion and mode of subserosal infiltration. In the present study, we analyzed 42 surgically-resected subserosal invasive gallbladder adenocarcinomas, invading the perimuscular connective tissue (pT2). The cumulative 5-year survival rate in the series was 48.7%. Lymphatic invasion (p=0.021), venous invasion (p=0.020), mode of subserosal infiltration (p<0.001), histological differentiation (p=0.030) and biliary infiltration (p=0.007) were noted, respectively, at a significantly higher incidence in more aggressive infiltration or poor differentiation in the DG type. The cumulative 5-year survival rate of curative resection cases was lower in patients with the DG type than in those with the IG type (68.9 versus 20.2%, respectively, p=0.006, log-rank test). On Cox’s proportional hazard regression modeling, the low degree of venous/perineural invasion and IG type of wall invasion pattern were associated with a significant improvement in overall survival. Our data suggest that the wall invasion pattern is an independent predictor of survival in subserosal invasive GBC. Regarding the clinical application of our concept, on the classification of patients with subserosal invasive GBC based on a combination of the wall invasion pattern and lymph node status, the overall survival rate in patients with the DG type and/or N2 metastasis (n=21) was lower than in patients with the IG type and N0, 1 metastasis (n=21) (p=0.0023, log-rank test). The wall invasion pattern could contribute to decision-making concerning curative resection for subserosal invasive GBC.
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