Hepatobiliary and Pancreatic Surgery Division, National Cancer Center Hospital, Tokyo, Japan.
Ann Surg Oncol. 2012 Oct;19(11):3567-73. doi: 10.1245/s10434-012-2599-5. Epub 2012 Aug 14.
The Union for International Cancer Control (UICC) and Japanese Society of Biliary Surgery (JSBS) staging systems differ in their staging of gallbladder cancer: they define hepatic invasion with or without invasion of another organ as T3 and either T3 or T4, respectively, and posterosuperior pancreatic lymph node (PSPLN) metastases as M1 and N2, respectively.
We retrospectively evaluated the survival of 224 patients who had undergone macroscopically curative resection for gallbladder cancer and assessed the influence of the differences between the two staging systems on survival.
JSBS staging stratified the survival curves better for stages III or IV. Fifty-seven patients were classified as UICC-T3 but JSBS-T4. These patients had better survival than did 43 patients with UICC-T4/JSBS-T4 and comparable survival to 17 patients with UICC-T3/JSBS-T3. UICC stage IIIB is composed of two subgroups: U-T2N1 (18 patients) and U-T3N1 (21 patients). Their 5-year survivals were 85 and 41%, respectively (P = 0.01). The latter was comparable to that of 28 T3N0 patients (35%, P = 0.93). The survival of the UICC-M1 patients with disease restricted to PSPLNs was significantly better than that of those with involvement beyond PSPLNs (5-year survival 35 vs. 17%; P = 0.04).
Although UICC staging more accurately defines the T category, JSBS staging better stratifies the prognosis of patients with gallbladder cancer, mainly because UICC stage IIIB includes T1/2N1M0, which is associated with significantly better survival than T3N0M0. It would be appropriate to classify PSPLNs as regional lymph nodes.
国际抗癌联盟 (UICC) 和日本胆道外科学会 (JSBS) 的胆囊癌分期系统存在差异：它们将肝侵犯伴或不伴其他器官侵犯定义为 T3 和 T3 或 T4，分别为 T3 和 T4，后上胰周淋巴结 (PSPLN) 转移定义为 M1 和 N2，分别为 N2。
我们回顾性评估了 224 例接受根治性手术治疗的胆囊癌患者的生存情况，并评估了两种分期系统之间的差异对生存的影响。
JSBS 分期对 III 期或 IV 期的生存曲线分层更好。57 例患者被归类为 UICC-T3 但 JSBS-T4。这些患者的生存状况优于 43 例 UICC-T4/JSBS-T4 患者，与 17 例 UICC-T3/JSBS-T3 患者的生存状况相当。UICC ⅢB 期由两个亚组组成：U-T2N1（18 例）和 U-T3N1（21 例）。它们的 5 年生存率分别为 85%和 41%（P=0.01）。后者与 28 例 T3N0 患者（35%，P=0.93）相当。局限于 PSPLN 的 UICC-M1 患者的生存状况明显优于超出 PSPLN 范围的患者（5 年生存率 35%对 17%；P=0.04）。
尽管 UICC 分期更准确地定义了 T 分期，但 JSBS 分期更好地分层了胆囊癌患者的预后，主要是因为 UICC ⅢB 期包括 T1/2N1M0，与 T3N0M0 相比，其生存率显著提高。将 PSPLN 归类为区域淋巴结更为合适。
