Jensen Eric H, Abraham Anasooya, Habermann Elizabeth B, Al-Refaie Waddah B, Vickers Selwyn M, Virnig Beth A, Tuttle Todd M
Division of Surgical Oncology, University of Minnesota Medical Center, 420 Delaware Street SE, MMC 195, Minneapolis, MN 55455, USA.
J Gastrointest Surg. 2009 Apr;13(4):722-7. doi: 10.1007/s11605-008-0772-8. Epub 2008 Dec 13.
Radical resection is recommended for selected patients with gallbladder (GB) cancer. We sought to determine whether radical resection improves survival for patients with early-stage cancer and to evaluate surgeon compliance with current treatment recommendations.
Patients with stage 0, I, or II GB cancer who underwent surgical resection were identified from the Surveillance, Epidemiology, and End Results (SEER) tumor registry from 1988 through 2004. Patients were classified by surgical procedure performed (simple vs. radical resection) and adjuvant treatment given (radiation therapy [RT] vs. no RT). Unadjusted and adjusted overall survival (OS) and cancer-specific survival (CSS) were compared.
Of the 4,631 patients who underwent surgery for early-stage GB cancer from 1988 through 2004, 4,188 (90.4%) underwent cholecystectomy alone and 443 (9.6%) underwent radical surgery including hepatic resection. The proportion of patients having radical surgery for T1b, T2, and T3 cancers was 4.5%, 5.6%, and 16.3%, respectively. For patients with T1b/T2 cancer, radical resection was associated with significant improvement in adjusted CSS (p = 0.01) and OS (p = 0.03). For patients with T3 cancers, we noted no improvement in CSS or OS. Survival for patients with node-positive disease (stage 2b) was universally poor and not improved by radical resection. For all patients who underwent radical resection, node negativity, female sex, age <70, low grade, and RT predicted improved CSS and OS.
Despite a significant survival advantage for patients with T1b/T2 GB cancer who undergo radical resection, this treatment is significantly underutilized. Ensuring delivery of recommended surgical treatment is vital to improving outcomes for patients with this disease.
对于部分胆囊癌患者，建议行根治性切除术。我们旨在确定根治性切除术是否能提高早期癌症患者的生存率，并评估外科医生对当前治疗建议的依从性。
从1988年至2004年的监测、流行病学和最终结果（SEER）肿瘤登记处中，识别出接受手术切除的0期、I期或II期胆囊癌患者。根据所施行的手术方式（单纯手术与根治性手术）和给予的辅助治疗（放射治疗[RT]与未行RT）对患者进行分类。比较未调整和调整后的总生存期（OS）及癌症特异性生存期（CSS）。
在1988年至2004年接受早期胆囊癌手术的4631例患者中，4188例（90.4%）仅接受了胆囊切除术，443例（9.6%）接受了包括肝切除术在内的根治性手术。T1b、T2和T3期癌症患者接受根治性手术的比例分别为4.5%、5.6%和16.3%。对于T1b/T2期癌症患者，根治性切除术与调整后的CSS（p = 0.01）和OS（p = 0.03）显著改善相关。对于T3期癌症患者，我们未观察到CSS或OS有改善。淋巴结阳性疾病（2b期）患者的生存率普遍较差，根治性切除术并未改善。对于所有接受根治性手术的患者，淋巴结阴性、女性、年龄<70岁、低分级和RT预示着CSS和OS改善。
尽管接受根治性切除术的T1b/T2期胆囊癌患者有显著的生存优势，但这种治疗方法的使用明显不足。确保提供推荐的手术治疗对于改善该疾病患者的预后至关重要。
