Kayahara Masato, Nagakawa Takukazu, Nakagawara Hisatoshi, Kitagawa Hirohisa, Ohta Tetsuo
Department of Gastroenterological Surgery, Division of Cancer Medicine, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Ann Surg. 2008 Nov;248(5):807-14. doi: 10.1097/SLA.0b013e31818a1561.
The objective of this study was to evaluate prognostic predictors for patients with gallbladder cancer (GBC) in a Japanese nationwide data base.
GBC is the most common cancer of the biliary tract in Japan. Differences in the survival rates between Japan and other countries have been noted.
The authors analyzed 4424 patients with GBC in Japan between 1988 and 1997. Staging was determined in accordance with American Joint Committee on Cancer stage.
Survival is related closely to the surgical stage. Five-year survival rates for stage I, II, III, IVA, and IVB (5th edition) were 83%, 70%, 45%, 23%, and 9%, respectively. These differences were significant (P < 0.0001). The survival rate for patients aged <60 years was significantly better (P < 0.05). The survival rate for patients aged >69 years was significantly worse (P < 0.01). The cholecystectomy plus combined resection of bile duct and/or liver bed resection had an effect on prolonging the survival in stage II or III disease, but extended resection did not. The patients with anomalous pancreaticobiliary ductal junction had a survival advantage over those with cholelithiasis by univariate analysis. However, multivariate analyses indicated that only age, sex, stage, operative procedures were independent prognostic factors. Stage was the strongest covariate; patients diagnosed with stage II, III, IVA, or IVB disease were 2.2, 4.2, 8.1, and 13.6 times, respectively, were more likely to die.
Staging is the strongest prognostic factor for GBC, but patient outcomes were also affected by age, sex, and operative procedures. The data do not support any advantage for extended resection. Neither gallstones nor anomalous pancreaticobiliary ductal junction influenced the GBC patient outcome.
本研究的目的是在一个日本全国性数据库中评估胆囊癌（GBC）患者的预后预测因素。
GBC是日本最常见的胆道癌症。日本与其他国家之间的生存率差异已被注意到。
作者分析了1988年至1997年间日本的4424例GBC患者。分期根据美国癌症联合委员会分期确定。
生存率与手术分期密切相关。I期、II期、III期、IVA期和IVB期（第5版）的5年生存率分别为83%、70%、45%、23%和9%。这些差异具有显著性（P < 0.0001）。年龄<60岁患者的生存率显著更好（P < 0.05）。年龄>69岁患者的生存率显著更差（P < 0.01）。胆囊切除术加胆管联合切除术和/或肝床切除术对II期或III期疾病患者的生存延长有影响，但扩大切除术则没有。通过单因素分析，胰胆管异常汇合患者的生存率优于胆结石患者。然而，多因素分析表明，只有年龄、性别、分期、手术方式是独立的预后因素。分期是最强的协变量；诊断为II期、III期、IVA期或IVB期疾病的患者死亡可能性分别高2.2倍、4.2倍、8.1倍和13.6倍。
分期是GBC最强的预后因素，但患者的预后也受年龄、性别和手术方式的影响。数据不支持扩大切除术有任何优势。胆结石和胰胆管异常汇合均未影响GBC患者的预后。
