Chijiiwa K, Noshiro H, Nakano K, Okido M, Sugitani A, Yamaguchi K, Tanaka M
Department of Surgery 1, Kyushu University Faculty of Medicine, Fukuoka, Japan.
World J Surg. 2000 Oct;24(10):1271-6; discussion 1277. doi: 10.1007/s002680010253.
The role of radical resection in the treatment of gallbladder carcinoma was examined with special reference to lymph node metastasis using two classifications: one proposed by the American Joint Committee on Cancer (AJCC) and the other by the Japanese Society of Biliary Surgery (JSBS). Histologic evaluations for the depth of tumor invasion (T), lymph node metastasis (N), stage, and follow-up for a mean period of 38 months (range 4-185 months) were completed in 52 patients with gallbladder carcinoma who underwent surgical resection from 1982 to 1997. The definition of T was similar in the two classifications. The extent of nodal involvement (N, AJCC; n, JSBS), stage, and survival were examined. In the absence of lymph node metastasis, the 5-year survival rate reached 71%. The 5-year survival rate in patients with involved nodes confined to the hepatoduodenal ligament, posterosuperior pancreaticoduodenal region, or along the common hepatic artery (N1 and part of N2 by AJCC; nl and n2 by JSBS) approximated 28%. In contrast, postoperative survival was poor in the presence of more extensive nodal involvement (rest of N2 by AJCC; n3 and n4 by JSBS), with no 2-year survivors. The definition of stage I was the same in both classifications, and all patients in this stage are alive. The 5-year survival rates in stages II and III by the AJCC were 70.7% and 22.4%, respectively, and those by JSBS 61.9% and 23.1%, respectively. Thus the survival rates in stages I to III were essentially similar irrespective of the staging system. Stage IV showed significantly worse survival than stage III by the JSBS classification. In contrast, the differentiation of stage IV from III by the AJCC was not significant because of the better survival in stage IV that contained any T with nodal involvement in the posterosuperior pancreaticoduodenal region and along the common hepatic artery. Radical resection should be considered for patients with stage I to III disease defined by either classification and applied to the tumor invasion up to T3 with nodal involvement confined to the hepatoduodenal ligament, posterosuperior pancreaticoduodenal region, and along the common hepatic artery. The role of radical surgery seems to be limited in patients with more extensive tumor invasion or lymph node metastasis.
采用美国癌症联合委员会（AJCC）和日本胆道外科学会（JSBS）提出的两种分类方法，特别参照淋巴结转移情况，研究了根治性切除术在胆囊癌治疗中的作用。对1982年至1997年接受手术切除的52例胆囊癌患者进行了肿瘤浸润深度（T）、淋巴结转移（N）、分期的组织学评估，并进行了平均38个月（范围4 - 185个月）的随访。两种分类中T的定义相似。检查了淋巴结受累范围（N，AJCC；n，JSBS）、分期和生存率。在无淋巴结转移的情况下，5年生存率达到71%。淋巴结受累局限于肝十二指肠韧带、胰十二指肠后上区域或沿肝总动脉（AJCC的N1和部分N2；JSBS的n1和n2）的患者，5年生存率约为28%。相比之下，淋巴结受累范围更广（AJCC的其余N2；JSBS的n3和n4）时，术后生存率较差，无2年存活者。两种分类中I期的定义相同，该期所有患者均存活。AJCC分期中II期和III期的5年生存率分别为70.7%和22.4%，JSBS分期中分别为61.9%和23.1%。因此，无论采用哪种分期系统，I至III期的生存率基本相似。根据JSBS分类，IV期的生存率明显低于III期。相比之下，AJCC将IV期与III期区分开来并不显著，因为IV期包含任何T且伴有胰十二指肠后上区域和沿肝总动脉淋巴结受累的患者生存率较高。对于两种分类所定义的I至III期疾病患者，应考虑进行根治性切除术，并应用于肿瘤浸润至T3且淋巴结受累局限于肝十二指肠韧带、胰十二指肠后上区域和沿肝总动脉的情况。对于肿瘤浸润范围更广或有淋巴结转移的患者，根治性手术的作用似乎有限。
