胆囊肉瘤样癌的外科治疗与预后。

Surgical therapy and prognosis of sarcomatoid carcinoma of the gallbladder.

机构信息

Division of Hepatobiliary and Pancreatic Surgery, Key Laboratory of Combined Multi-organ Transplantation, Zhejiang University School of Medicine, Hangzhou 310003, China

出版信息

Hepatobiliary Pancreat Dis Int. 2010 Apr;9(2):175-9.

PMID:20382590

Abstract

BACKGROUND

Sarcomatoid carcinoma of the gallbladder is rare and its characteristics are poorly understood. This study aimed to understand the behavior and prognosis of sarcomatoid carcinoma of the gallbladder as well as its clinical manifestations and survival rate of patients after radical or palliative surgery, and to review the reported data worldwide and our 10 patients.

METHODS

From 2004 to 2009, ten patients were pathologically diagnosed with sarcomatoid carcinoma of the gallbladder and underwent operation at our center. These characteristics, clinical presentations, tumor-node-metastasis (TNM) staging, surgical modes, and prognosis were reviewed, retrospectively. We collected the data of 46 patients reported in the English-language literature worldwide and analyzed the survival with ours. The survival rate was estimated using the Kaplan-Meier method, and was compared using the log-rank test.

RESULTS

The median age of the 10 patients was 67 years (inter-quartile range 59-74 years), and the size of tumor inter-quartile ranged from 3.1 to 7.9 cm. In this series, 9 patients received radical surgery, and one undewent palliative surgery. There was no surgical mortality, and one patient underwent a second operation because of liver metastasis. The median survival time of the patients was 9 months (inter-quartile range 6-12 months), with 3 patients still being alive until follow-up; however, two patients had tumor recurrence. The data from the 56 patients (10 patients in our series and 46 reported elsewhere) statistically indicated that the median age was 66 years (inter-quartile range 61-74.5 years) and the overall median survival was 5.5 months (inter-quartile range 2.5-10 months). The survival time in the patients undergoing radical surgery (n=42) was significantly longer than that in the patients undergoing palliative surgery (n=14)(P=0.031).

CONCLUSIONS

The survival of the patients with sarcomatoid carcinoma of the gallbladder is poor. Some patients may die shortly after the surgery because of recurrence or metastasis. However, radical surgery is still necessary if possible.

摘要

背景

胆囊肉瘤样癌罕见，其特征尚未完全阐明。本研究旨在了解胆囊肉瘤样癌的行为和预后，以及根治性或姑息性手术后患者的临床表现和生存率，并对全球报道数据和我们的 10 例患者进行复习。

方法

2004 年至 2009 年，我们中心对 10 例经病理诊断为胆囊肉瘤样癌的患者进行了手术。回顾性分析这些患者的特征、临床表现、肿瘤-淋巴结-转移（TNM）分期、手术方式和预后。我们收集了全球范围内以英文发表的 46 例患者的数据，并与我们的资料进行了分析。采用 Kaplan-Meier 法估计生存率，并采用对数秩检验比较生存率。

结果

10 例患者的中位年龄为 67 岁（四分位间距 59-74 岁），肿瘤大小的四分位间距为 3.1-7.9cm。本系列中，9 例患者接受根治性手术，1 例患者接受姑息性手术。无手术死亡病例，1 例患者因肝转移行二次手术。患者的中位生存时间为 9 个月（四分位间距 6-12 个月），随访时 3 例患者仍存活，但 2 例患者肿瘤复发。10 例患者（本研究 10 例，其他 46 例）的资料经统计学分析表明，中位年龄为 66 岁（四分位间距 61-74.5 岁），总体中位生存时间为 5.5 个月（四分位间距 2.5-10 个月）。根治性手术（n=42）患者的生存时间明显长于姑息性手术（n=14）患者（P=0.031）。