Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
J Am Coll Surg. 2011 Jan;212(1):50-61. doi: 10.1016/j.jamcollsurg.2010.09.009. Epub 2010 Nov 12.
Gallbladder cancer (GBCA) is a rare malignancy with a variable incidence worldwide. This study analyzed GBCA patients treated at centers in 3 countries. The aim was to assess for location-specific differences in presentation and outcomes, which might suggest differences in pathogenesis or disease biology.
Data for consecutive patients submitted to operation at Instituto Oncológico Fundación Arturo López Pérez (FALP, Chile), Yokohama City University (YCU, Japan), and Memorial Sloan-Kettering Cancer Center (MSKCC, USA) between 1999 and 2007 were studied retrospectively. Patient demographics, disease- and treatment-related variables and outcomes were analyzed by chi-square, Kruskal-Wallis, and log-rank test.
Two hundred sixty-one patients (MSKCC, 130; FALP, 85; YCU, 46) underwent exploration, and 160 (MSKCC, 91; FALP, 33; YCU, 36) underwent R0 resection. Patients treated at FALP were younger (median 57 years, p < 0.001) and more often female (80%, p < 0.005); at YCU there were fewer patients with incidental tumors (19.5% compared with more than 60% at FALP and MSKCC, p < 0.001). En bloc liver and bile duct resections were performed more commonly at MSKCC and YCU (p < 0.001). Patients treated at FALP had more advanced tumor stage compared with those treated at MSKCC and YCU (p < 0.001). Disease-specific survival (DSS) was not different among the groups when patients submitted to an R0 resection were analyzed (p = 0.12). On multivariate analysis, T-stage, nodal involvement, and bile duct involvement were predictors of DSS; center was not significant.
Despite some differences in presentation, disease extent, and surgical treatment, DSS after curative intent resection was similar among all 3 groups. The most important predictors of outcomes were related to tumor extent rather than country of origin.
胆囊癌（GBCA）是一种罕见的恶性肿瘤，其发病率在全球范围内存在差异。本研究分析了在 3 个国家的中心治疗的 GBCA 患者。目的是评估特定部位的表现和结果差异，这可能表明发病机制或疾病生物学的差异。
回顾性分析了 1999 年至 2007 年间在 Fundación Arturo López Pérez 肿瘤研究所（FALP，智利）、横滨市立大学（YCU，日本）和 Memorial Sloan-Kettering 癌症中心（MSKCC，美国）接受手术的连续患者的数据。通过卡方检验、克鲁斯卡尔-沃利斯检验和对数秩检验分析患者的人口统计学、疾病和治疗相关变量及结果。
261 例患者（MSKCC 130 例，FALP 85 例，YCU 46 例）接受了探查，160 例（MSKCC 91 例，FALP 33 例，YCU 36 例）接受了 R0 切除。FALP 治疗的患者年龄较小（中位年龄 57 岁，p < 0.001），女性比例较高（80%，p < 0.005）；YCU 中偶然发现肿瘤的患者较少（19.5%，而 FALP 和 MSKCC 中超过 60%，p < 0.001）。MSKCC 和 YCU 更常进行整块肝和胆管切除术（p < 0.001）。与 MSKCC 和 YCU 相比，FALP 治疗的患者肿瘤分期更晚（p < 0.001）。当分析接受 R0 切除的患者时，各组之间的疾病特异性生存率（DSS）无差异（p = 0.12）。多因素分析显示，T 分期、淋巴结受累和胆管受累是 DSS 的预测因素；中心无显著性差异。
尽管在表现、疾病程度和手术治疗方面存在一些差异，但根治性切除术后的 DSS 在所有 3 组中相似。影响预后的最重要因素与肿瘤程度有关，而与起源国无关。
