Wright Byron E, Lee Chris C, Iddings Douglas M, Kavanagh Maihgan, Bilchik Anton J
Department of Surgical Oncology, Division of Gastrointestinal Surgical Oncology, John Wayne Cancer Institute at St. John's Health Center, 2200 Santa Monica Blvd, Santa Monica, CA 90404, USA.
Am J Surg. 2007 Dec;194(6):820-5; discussion 825-6. doi: 10.1016/j.amjsurg.2007.08.032.
The national recommendation for the management of localized T2 gallbladder cancer (GBCA) is radical cholecystectomy. Although reported survival for localized T2 disease has been poor, groups have documented improvement with radical resection. We hypothesized that a discrepancy exists between national recommendations and current practice patterns.
Patients diagnosed with localized T2 GBCA between 1988 and 2002 were identified from the Surveillance, Epidemiology, and End Results registry. Age, sex, race, ethnicity, extent of surgery, and overall survival were assessed. Surgical procedure was categorized as cholecystectomy alone (CS), cholecystectomy plus lymph node dissection (CS+LN), radical cholecystectomy (RCS), or other. Survival calculations were made using the Kaplan-Meier method and compared with the log-rank test.
Of 382 patients with pathologically confirmed T2 GBCA, 280 were women. The median patient age was 75 years. A total of 238 patients underwent CS, 76 underwent CS+LN, and 14 underwent RCS. The remaining 54 patients underwent a lesser or no procedure and were excluded from comparative analysis. The median survival was 14 months for all patients and 14, 14, and 8 months for subgroups treated with CS, CS+LN, and RCS, respectively. Rates of 5-year survival were 23%, 24%, and 36% for CS, CS+LN, and RCS subgroups, respectively. There was no significant difference in survival rates between RCS and CS+LN, or between RCS and CS.
The majority of patients with T2 GBCA in the United States are not managed according to current national recommendations.
对于局限性T2期胆囊癌（GBCA）的治疗，国家推荐的方法是根治性胆囊切除术。尽管据报道局限性T2期疾病的生存率较差，但一些研究组已证明根治性切除可改善预后。我们推测国家推荐与当前的实践模式之间存在差异。
从监测、流行病学和最终结果登记处识别出1988年至2002年间诊断为局限性T2期GBCA的患者。评估患者的年龄、性别、种族、民族、手术范围和总生存率。手术方式分为单纯胆囊切除术（CS）、胆囊切除术加淋巴结清扫术（CS+LN）、根治性胆囊切除术（RCS）或其他。使用Kaplan-Meier方法进行生存计算，并与对数秩检验进行比较。
在382例经病理证实为T2期GBCA的患者中，280例为女性。患者的中位年龄为75岁。共有238例患者接受了CS，76例接受了CS+LN，14例接受了RCS。其余54例患者接受了较小的手术或未接受手术，并被排除在比较分析之外。所有患者的中位生存期为14个月，接受CS、CS+LN和RCS治疗的亚组患者的中位生存期分别为14、14和8个月。CS、CS+LN和RCS亚组的5年生存率分别为23%、24%和36%。RCS与CS+LN之间或RCS与CS之间的生存率无显著差异。
美国大多数T2期GBCA患者未按照当前国家推荐的方法进行治疗。
