Prognostic Factors in Patients With Gallbladder Cancer After Surgical Resection Analysis of 279 Operated Patients
Prognostic Factors in Patients With Gallbladder Cancer After Surgical Resection Analysis of 279 Operated Patients
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DOI：
10.1097/mcg.0b013e3182703409
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发表时间：
2013-05-01
影响因子：
2.9
通讯作者：
Hwang, Shin
中科院分区：
文献类型：
--
作者：
Lim, Hyun;Seo, Dong Wan;Hwang, Shin
背景：识别预后因素有助于预测预期寿命和决定治疗方案。我们评估了手术切除后胆囊癌（GBC）患者的预后因素。研究：回顾性分析了1999年1月至2009年2月期间接受手术的279例GBC患者的数据。结果：在279例患者中，127例（45.5%）为男性;中位年龄为63岁。164例（58.8%）患者实现了R 0切除，35例通过胆囊切除术，129例通过扩大切除术。化疗72例（25.8%），放疗55例（19.7%）。中位随访时间为17.0个月，中位总生存期（OS）为26.0个月。I、II、IIIA、IIIB、IVA和IVB期GBC的5年生存率分别为94.7%、75.7%、44.5%、21.7%、4.7%和2.6%。与胆囊切除术相比，扩大切除术在所有T分期的OS均有所改善，但仅在T3（P < 0.001）和T4（P = 0.007）中观察到统计学意义。虽然接受化疗或放疗的患者的OS相似，但放疗显著提高了切缘阳性患者的OS（P = 0.023）。低级别的组织学类型（P = 0.047）和清晰的切除边缘（P = 0.002）是增加OS的显著预测因素，但流行病学因素如胆结石和异常胰胆管连接不是。预后还与切除范围、组织分化和切缘受累有关。在切缘阳性的患者中，放疗似乎延长了OS。
Background: Identification of prognostic factors can help predict life expectancy and decide treatment plan. We evaluated prognostic factors in patients with gallbladder cancer (GBC) after surgical resection.Study: Data from 279 patients with GBC who underwent surgery between January 1999 and February 2009 were reviewed retrospectively.Results: Of the 279 patients, 127 (45.5%) were male; median age was 63 years. R0 resection was achieved in 164 (58.8%) patients, 35 by cholecystectomy and 129 by extended resection. Chemotherapy and radiotherapy were performed in 72 (25.8%) and 55 (19.7%) patients. At a median follow-up of 17.0 months, median overall survival (OS) was 26.0 months. Five-year survival rates for stages I, II, IIIA, IIIB, IVA, and IVB GBC were 94.7%, 75.7%, 44.5%, 21.7%, 4.7%, and 2.6%, respectively. Compared with cholecystectomy, extended resection showed improved OS in all T stages, but statistical significance was observed only in T3 (P < 0.001) and T4 (P = 0.007). Although OS was similar in patients who received chemotherapy or radiotherapy, radiotherapy significantly improved OS in patients with positive resection margin (P = 0.023). Low-grade histologic type (P = 0.047) and clear resection margin (P = 0.002) were significant predictors of increased OS, but epidemiological factors such as gallstones and anomalous pancreaticobiliary ductal union were not.Conclusions: In patients with GBC after surgical resection, TNM stage was the most important prognostic factor. Prognosis was also associated with extent of resection, histologic differentiation, and involvement of resection margin. In patients with positive resection margin, radiotherapy seems to prolong OS.