Gallbladder Cancer: Differences in Presentation, Surgical Treatment, and Survival in Patients Treated at Centers in Three Countries
Gallbladder Cancer: Differences in Presentation, Surgical Treatment, and Survival in Patients Treated at Centers in Three Countries
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DOI：
10.1016/j.jamcollsurg.2010.09.009
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发表时间：
2011-01-01
影响因子：
5.2
通讯作者：
Jarnagin, William R.
中科院分区：
文献类型：
--
作者：
Butte, Jean M.;Matsuo, Kenichi;Jarnagin, William R.
背景：胆囊癌（GBCA）是一种罕见的恶性肿瘤，在世界范围内的发病率各不相同。本研究分析了在3个国家的中心接受治疗的GBCA患者。其目的是评估在表现和结果方面的位置特异性差异，这可能表明在发病机制或疾病生物学方面的差异。在Institut Oncologico丰达西翁Arturo洛佩斯佩雷斯接受手术的连续患者的数据（智利），横滨市立大学（YCU，日本），和纪念斯隆-凯特琳癌症中心（MSKCC，美国）之间的1999年和2007年进行了回顾性研究。患者的人口统计学资料，疾病和治疗相关的变量和结果进行了分析卡方，Kruskal-Wallis，和log-rank test.Results：261例患者（MSKCC，130; CIPP 85; YCU，46）进行了勘探，和160（MSKCC，91; CIPP 33; YCU，36）进行了R 0切除。在YCU接受治疗的患者更年轻（中位数57岁，p < 0.001），女性更常见（80%，p < 0.005）;在YCU，偶发肿瘤的患者更少（19.5%，而在YCLP和MSKCC超过60%，p < 0.001）。MSKCC和YCU更常进行肝和胆管整体切除术（p < 0.001）。与MSKCC和YCU治疗的患者相比，接受CVP治疗的患者具有更晚期的肿瘤分期（p < 0.001）。当对接受R 0切除术的患者进行分析时，各组之间的疾病特异性生存期（DSS）没有差异（p = 0.12）。在多变量分析，T阶段，淋巴结的参与，胆管参与预测DSS;中心是不显着的。结论：尽管在介绍，疾病的程度，和手术治疗有一定的差异，根治性切除术后的DSS是相似的所有3组。最重要的预后预测因素与肿瘤范围有关，而不是来源国。（美国科尔外科杂志2011; 212：50-61。(C)2011年美国外科医生学会）
BACKGROUND: Gallbladder cancer (GBCA) is a rare malignancy with a variable incidence worldwide. This study analyzed GBCA patients treated at centers in 3 countries. The aim was to assess for location-specific differences in presentation and outcomes, which might suggest differences in pathogenesis or disease biology.STUDY DESIGN: Data for consecutive patients submitted to operation at Institut Oncologico Fundacion Arturo Lopez Perez (FALP, Chile), Yokohama City University (YCU, Japan), and Memorial Sloan-Kettering Cancer Center (MSKCC, USA) between 1999 and 2007 were studied retrospectively. Patient demographics, disease- and treatment-related variables and outcomes were analyzed by chi-square, Kruskal-Wallis, and log-rank test.RESULTS: Two hundred sixty-one patients (MSKCC, 130; FALP, 85; YCU, 46) underwent exploration, and 160 (MSKCC, 91; FALP, 33; YCU, 36) underwent R0 resection. Patients treated at FALP were younger (median 57 years, p < 0.001) and more often female (80%, p < 0.005); at YCU there were fewer patients with incidental tumors (19.5% compared with more than 60% at FALP and MSKCC, p < 0.001). En bloc liver and bile duct resections were performed more commonly at MSKCC and YCU (p < 0.001). Patients treated at FALP had more advanced tumor stage compared with those treated at MSKCC and YCU (p < 0.001). Disease-specific survival (DSS) was not different among the groups when patients submitted to an R0 resection were analyzed (p = 0.12). On multivariate analysis, T-stage, nodal involvement, and bile duct involvement were predictors of DSS; center was not significant.CONCLUSIONS: Despite some differences in presentation, disease extent, and surgical treatment, DSS after curative intent resection was similar among all 3 groups. The most important predictors of outcomes were related to tumor extent rather than country of origin. (J Am Coll Surg 2011; 212:50-61. (C) 2011 by the American College of Surgeons)