Todoroki T, Takahashi H, Koike N, Kawamoto T, Kondo T, Yoshida S, Kashiwagi H, Otsuka M, Fukao K, Saida Y
Department of Surgery, University of Tsukuba, Japan.
Hepatogastroenterology. 1999 Jul-Aug;46(28):2114-21.
BACKGROUND/AIMS: Stage IV gallbladder carcinoma patients are rarely considered treatable by resection. They resign themselves to palliation because there is no long-term survival data available on the risks of morbidity and mortality following aggressive treatment. The aim of this study was to evaluate predictors of survival following aggressive resection surgery for stage IV gallbladder carcinoma.
In this retrospective study, we examined 93 patients with stage IV gallbladder carcinoma who had undergone resections. Of the 93 patients, 69 had undergone liver resection to various extents together with hepaticocholedochus resection (HCR); 2 had undergone pancreaticoduodenectomy (PD) both with and without HCR; 31 had undergone hepatopancreaticoduodenectomy (HPD); 7 had undergone cholecystectomy together with HCR; 12 had undergone cholecystectomy; and 3 had undergone extended cholecystectomy. Fifty of the 93 patients had also undergone adjuvant radiotherapy. Using univariate and multivariate analyses, 13 clinicopathologic risk factors were analyzed to predict survival.
Operative morbidity and mortality rates were 17.2% and 5.4%, respectively. Overall, the 5-year survival rate and median survival time were 9.8% and 243 days, respectively. The 5-year survival rate was significantly higher in stage IVA (n = 17) than in stage IVB (n = 76), at 42.8% and 4.9%, respectively. Multivariate analysis revealed that sex, histopathologic type, lymph node involvement (N), subgroup of stage IV, post-resection residual tumors, and adjuvant radiotherapy were significant predictors of survival.
Long-term survival, with acceptable mortality and morbidity, can be expected in female patients who have stage IVA gallbladder cancer consisting of well-differentiated adenocarcinoma and who undergo either complete microscopic resection or grossly complete resection followed by adjuvant radiotherapy.
背景/目的：IV期胆囊癌患者很少被认为可通过手术切除进行治疗。他们只能接受姑息治疗，因为目前尚无关于积极治疗后发病和死亡风险的长期生存数据。本研究的目的是评估IV期胆囊癌积极切除术后的生存预测因素。
在这项回顾性研究中，我们检查了93例接受过手术切除的IV期胆囊癌患者。在这93例患者中，69例不同程度地接受了肝切除联合肝外胆管切除术（HCR）；2例接受了胰十二指肠切除术（PD），其中1例联合HCR，1例未联合；31例接受了肝胰十二指肠切除术（HPD）；7例接受了胆囊切除联合HCR；12例接受了胆囊切除术；3例接受了扩大胆囊切除术。93例患者中有50例还接受了辅助放疗。通过单因素和多因素分析，对13个临床病理危险因素进行分析以预测生存情况。
手术发病率和死亡率分别为17.2%和5.4%。总体而言，5年生存率和中位生存时间分别为9.8%和243天。IVA期（n = 17）的5年生存率显著高于IVB期（n = 76），分别为42.8%和4.9%。多因素分析显示，性别、组织病理学类型、淋巴结受累情况（N）、IV期亚组、切除术后残留肿瘤以及辅助放疗是生存的重要预测因素。
对于患有高分化腺癌的IVA期胆囊癌女性患者，若接受显微镜下完全切除或大体上完全切除，随后进行辅助放疗，则有望获得可接受的死亡率和发病率的长期生存。
