Rates and patterns of recurrence after curative intent resection for gallbladder cancer: a multi-institution analysis from the US Extra-hepatic Biliary Malignancy Consortium
Rates and patterns of recurrence after curative intent resection for gallbladder cancer: a multi-institution analysis from the US Extra-hepatic Biliary Malignancy Consortium
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DOI：
10.1016/j.hpb.2016.05.016
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发表时间：
2016-11-01
期刊：
影响因子：
2.9
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Margonis, Georgios Antonios;Gani, Faiz;Pawlik, Timothy M.
背景：胆囊癌是一种相对罕见的恶性肿瘤。目前的研究目的是确定复发的发病率和模式，以下gallobular cancer surgery.Methods：使用多机构队列，我们确定了217例患者接受根治性手术治疗胆囊癌。复发模式分为局部复发和远处复发。结果：在最后一次随访时，76例（35.0%）患者出现了复发（局部复发，n = 12，15.8%;远处复发，n = 50，65.8%;局部和远处复发，n = 14，18.4%）。中位复发时间为9.5个月（IQR 4.7-17.6），与复发部位无关（所有p > 0.05）。在多变量分析中，T3病变（HR = 8.44，p = 0.014）、淋巴管浸润（HR = 4.24，p < 0.001）和残留病变（HR = 2.04，p = 0.042）与复发风险增加相关。复发患者的1年、3年和5年OS较差（1年OS：91.3% vs. 68.6%，p = 0.001，3年OS：79.3% vs. 28.7%，p < 0.001，5年OS：75.9% vs. 16.0%，p < 0.001）。在调整其他风险因素后，复发与OS降低独立相关（HR = 3.71，p = 0.006）。值得注意的是，接受辅助治疗与改善OS（HR = 0.56，p = 0.027）在这些患者谁开发的肿瘤recursion.Discussion：超过三分之一的患者经历了胆囊癌手术后复发。虽然化疗并没有降低复发率，但接受辅助治疗后复发的患者比未接受辅助治疗的患者表现更好。
Background: Gallbladder cancer is a relatively rare malignancy. The current study aimed to define the incidence and patterns of recurrence following gallbladder cancer resection.Methods: Using a multi-institutional cohort we identified 217 patient undergoing curative intent surgery for gallbladder cancer. Patterns of recurrence were classified as locoregional and distant recurrence.Results: At last follow-up, 76 patients (35.0%) had experienced a recurrence (locoregional only, n = 12, 15.8%; distant only, n = 50, 65.8%; locoregional and distant, n = 14, 18.4%). Median time to recurrence was 9.5 months (IQR 4.7-17.6) and was not associated with recurrence site (all p > 0.05). On multi variable analysis, T3 disease (HR = 8.44, p = 0.014), lymphovascular invasion (HR = 4.24, p < 0.001) and residual disease (HR = 2.04, p = 0.042) were associated with an increased risk of recurrence. Patients who recurred demonstrated a worse 1-, 3- and 5-year OS (1-year OS: 91.3% vs. 68.6%, p = 0.001, 3 year OS: 79.3% vs. 28.7%, p < 0.001, and 5-year OS: 75.9% vs. 16.0%, p < 0.001). After adjusting for other risk factors, recurrence was independently associated with a decreased OS (HR = 3.71, p = 0.006). Of note, receipt of adjuvant therapy was associated with improved OS (HR = 0.56, p = 0.027) among those patients who developed a tumor recurrence.Discussion: Over one-third of patients experienced a recurrence after gallbladder cancer surgery. While chemotherapy did not decrease the rate of recurrence, patients who experienced recurrence after administration of adjuvant treatment faired better than patients who did not receive adjuvant therapy.