监测、流行病学与最终结果数据库中的早期胆囊癌：扩大手术切除的效果

Early-stage gallbladder cancer in the Surveillance, Epidemiology, and End Results database: effect of extended surgical resection.

作者信息

Downing Stephanie R, Cadogan Kerry-Ann, Ortega Gezzer, Oyetunji Tolulope A, Siram Suryanarayana M, Chang David C, Ahuja Nita, Leffall LaSalle D, Frederick Wayne A I

机构信息

Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA.

出版信息

Arch Surg. 2011 Jun;146(6):734-8. doi: 10.1001/archsurg.2011.128.

DOI:10.1001/archsurg.2011.128

PMID:21690451

Abstract

HYPOTHESIS

Extended surgical resection (ESR) may improve survival in patients with early-stage primary gallbladder cancer.

DESIGN

Retrospective analysis of findings in the Surveillance, Epidemiology, and End Results (SEER) database.

SETTING

Academic research.

PATIENTS

Individuals with potentially surgically curable gallbladder cancer (Tis, T1, or T2) who underwent a surgical procedure.

MAIN OUTCOME MEASURES

Overall survival, number of lymph nodes (LNs) excised, and results of simple cholecystectomy vs ESR.

RESULTS

We identified 3209 patients with early-stage gallbladder cancer (11.7% Tis, 30.1% T1, and 58.2% T2). On multivariate analysis, decreased survival was noted among patients older than 60 years (hazard ratio, 1.57; 95% confidence interval, 1.30-1.90), among patients with more advanced cancer (1.99; 1.46-2.70 for T1; 3.29; 2.45-4.43 for T2), and among patients with disease-positive LNs (1.65; 1.39-1.95 for regional; 2.58; 1.54-4.34 for distant) (P < .001 for all), while increased survival was observed among female patients (0.82; 0.70-0.96; P = .02) and among patients undergoing ESR (0.59; 0.45-0.78; P < .001). The survival advantage of ESR was seen only in patients with T2 lesions (0.49; 0.35-0.68; P < .001). Lymph node excision data were available for a subset of 2507 patients, of whom 68.2% had no LN excised, 28.2% had 1 to 4 LNs excised, and 3.6% had 5 or more LNs excised. On multivariate analysis, patients with 1 to 4 LNs excised had a survival benefit over those with no LN excised (HR, 0.55; 95% CI, 0.46-0.66; P < .001), and patients with 5 or more LNs excised had a survival benefit over patients with 1 to 4 LNs removed (0.63; 0.40-0.96; P = .03). Lymph node excision improved survival in patients with T2 lesions (0.42; 0.33-0.53; P < .001 for patients with 1-4 LNs excised).

CONCLUSION

Extended surgical resection, LN excision, or both may improve survival in certain patients with incidentally discovered gallbladder cancer.

摘要

假设

扩大手术切除（ESR）可能提高早期原发性胆囊癌患者的生存率。

设计

对监测、流行病学和最终结果（SEER）数据库中的研究结果进行回顾性分析。

研究背景

学术研究。

患者

接受手术治疗的具有潜在手术可治愈性胆囊癌（Tis、T1或T2）的个体。

主要观察指标

总生存率、切除的淋巴结数量以及单纯胆囊切除术与ESR的结果。

结果

我们确定了3209例早期胆囊癌患者（11.7%为Tis，30.1%为T1，58.2%为T2）。多因素分析显示，60岁以上患者生存率降低（风险比，1.57；95%置信区间，1.30 - 1.90），癌症分期较晚的患者生存率降低（T1为1.99；1.46 - 2.70；T2为3.29；2.45 - 4.43），有淋巴结转移的患者生存率降低（区域转移为1.65；1.39 - 1.95；远处转移为2.58；1.54 - 4.34）（所有P < 0.001），而女性患者生存率增加（0.82；0.70 - 0.96；P = 0.02），接受ESR的患者生存率增加（0.59；0.45 - 0.78；P < 0.001）。ESR的生存优势仅在T2期病变患者中可见（0.49；0.35 - 0.68；P < 0.001）。2507例患者的子集有淋巴结切除数据，其中68.2%未切除淋巴结，28.2%切除1至4个淋巴结，3.6%切除5个或更多淋巴结。多因素分析显示，切除1至4个淋巴结的患者比未切除淋巴结的患者有生存获益（风险比，0.55；95%置信区间，0.46 - 0.66；P < 0.001），切除5个或更多淋巴结的患者比切除1至4个淋巴结的患者有生存获益（0.63；0.40 - 0.96；P = 0.03）。淋巴结切除可提高T2期病变患者的生存率（切除1 - 4个淋巴结的患者P < 0.001）。