Undertreatment of Gallbladder Cancer: A Nationwide Analysis
Undertreatment of Gallbladder Cancer: A Nationwide Analysis
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DOI：
10.1245/s10434-021-09607-6
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发表时间：
2021-02-10
影响因子：
3.7
通讯作者：
Sachs, Teviah E.
中科院分区：
文献类型：
--
作者：
Papageorge, Marianna, V;de Geus, Susanna W. L.;Sachs, Teviah E.
胆囊癌死亡率高，发病率呈上升趋势。目前的国家综合癌症网络（NCCN）指南建议对所有T1b和更高阶段的癌症进行切除。本研究旨在评估胆囊癌患者的再切除率和相关的生存影响。方法从国家癌症数据库（2004-2015）中筛选胆囊腺癌切除术患者。再切除定义为首次手术后180天内的最终手术。倾向评分是为患者再次切除的几率创建的。患者按1:2配对。采用Kaplan-Meier和Cox比例风险法进行生存分析。结果共纳入6175例患者，其中466例（7.6%）进行了再切除。再切除与中位年龄较年轻（65岁对72岁，p < 0.0001）、私人保险（41.6%对27.1%,p < 0.0001）、学术中心（50.4%对29.7%,p < 0.0001）和治疗地点在东北部（22.8%对20.4%,p = 0.0011）相关。与未进行再切除的患者相比，再切除与pT分期（pT2: 47.6% vs 42.8%, p = 0.0139）和pN分期（pN1-2: 28.1% vs 20.7%, p < 0.0001）、最终病理阴性边缘（90.1% vs 72.6%, p < 0.0001）和接受化疗（53.7% vs 35.8%, p < 0.0001）相关。接受再切除的患者的总生存期（OS）明显高于未接受再切除的患者（中位OS， 44.0 vs 23.0个月；p < 0.0001）。在倾向评分匹配后，再次切除仍然与更高的生存期相关（中位OS， 44.0 vs 31.0个月；p = 0.0004）。结论：胆囊癌的再切除与生存率的提高相关，但仍未得到充分利用，特别是对早期疾病。
Background Gallbladder cancer has a high mortality rate and an increasing incidence. The current National Comprehensive Cancer Network (NCCN) guidelines recommend resection for all T1b and higher-stage cancers. This study aimed to evaluate re-resection rates and the associated survival impact for patients with gallbladder cancer. Methods Patients with gallbladder adenocarcinoma who underwent resection were identified from the National Cancer Database (2004-2015). Re-resection was defined as definitive surgery within 180 days after the first operation. Propensity scores were created for the odds of a patient having a re-resection. Patients were matched 1:2. Survival analyses were performed using the Kaplan-Meier and Cox proportional hazard methods. Results The study identified 6175 patients, and 466 of these patients (7.6%) underwent re-resection. Re-resection was associated with younger median age (65 vs 72 years; p < 0.0001), private insurance (41.6% vs 27.1%; p < 0.0001), academic centers (50.4% vs 29.7%; p < 0.0001), and treatment location in the Northeast (22.8% vs 20.4%; p = 0.0011). Compared with no re-resection, re-resection was associated with pT stage (pT2: 47.6% vs 42.8%; p = 0.0139) and pN stage (pN1-2: 28.1% vs 20.7%; p < 0.0001), negative margins on final pathology (90.1% vs 72.6%; p < 0.0001), and receipt of chemotherapy (53.7% vs 35.8%; p < 0.0001). The patients who underwent re-resection demonstrated significantly longer overall survival (OS) than the patients who did not undergo re-resection (median OS, 44.0 vs 23.0 months; p < 0.0001). After propensity score-matching, re-resection remained associated with superior survival (median OS, 44.0 vs 31.0 months; p = 0.0004). Conclusions Re-resection for gallbladder cancer is associated with improved survival but remains underused, particularly for early-stage disease.