Hopital Saint Luc-CHUM, Service de chirurgie hépatobiliaire et pancréatique, Université de Montréal, Canada.
Eur J Surg Oncol. 2013 Jun;39(6):548-53. doi: 10.1016/j.ejso.2013.02.010. Epub 2013 Mar 21.
This report examines the patterns of presentation, prognostic factors and survival rate of all patients with gallbladder cancer (GBC) evaluated at our tertiary academic hospital over an 11-year period.
A retrospective review of a prospectively collected database of all patients with GBC presenting between January 1998 and December 2008 was performed.
102 GBC-patients were included: 69 women and 33 men (median age: 65,5 years). Forty-five patients presented with incidental gallbladder cancer (IGC) and 57 with nonincidental cancer (NIGC). Curative surgery rate was 84.4% for IGC and 29.8% for NIGC (p < 0.001). Five-year actuarial survival rate was 63.2% for patients with curative intent surgery and 0% for patients with palliative approach. Patients with IGC had a longer survival rate compared to patients with NIGC (median: 25.8 vs. 4.4 months, p < 0.0001). For patients with radical resection (42 patients), there was no difference between IGC and NIGC. The incidence of liver involvement was respectively 0%, 20.8%, 58.3%, 100% for pT1, pT2, pT3 and pT4 tumors. Univariate analysis showed that survival rate was significantly affected by perineural invasion, T, N and M-stage, R0 resection, liver involvement, CA-19.9. In multivariate analysis, liver involvement was the only independent factor.
Majority of patients with a potentially curable disease had IGC. Almost 80% of patients with NIGC presented with unresectable disease. For patients who underwent resection with curative intent, actuarial 5-year survival was 63.2%. Liver involvement was the only independent prognostic factor. All patients with IGC and a pT2 or more advanced T stage should undergo a second radical resection.
本报告研究了在我们的三级学术医院 11 年间评估的所有胆囊癌（GBC）患者的表现模式、预后因素和生存率。
对 1998 年 1 月至 2008 年 12 月期间所有 GBC 患者的前瞻性数据库进行回顾性分析。
共纳入 102 例 GBC 患者：69 例女性和 33 例男性（中位年龄：65.5 岁）。45 例为偶然发现的胆囊癌（IGC），57 例为非偶然发现的癌症（NIGC）。IGC 的根治性手术率为 84.4%，NIGC 为 29.8%（p<0.001）。有根治性手术意愿的患者 5 年生存率为 63.2%，姑息治疗的患者为 0%。IGC 患者的生存率明显长于 NIGC 患者（中位：25.8 与 4.4 个月，p<0.0001）。对于根治性切除（42 例）的患者，IGC 和 NIGC 之间无差异。肿瘤 pT1、pT2、pT3 和 pT4 的肝侵犯发生率分别为 0%、20.8%、58.3%和 100%。单因素分析显示，生存率受神经周围侵犯、T、N 和 M 分期、R0 切除、肝侵犯、CA-19.9 显著影响。多因素分析显示，肝侵犯是唯一独立的预后因素。有根治性手术意愿的患者中，5 年生存率为 63.2%。肝侵犯是唯一的独立预后因素。所有 IGC 患者和更高级别的 T 期 pT2 患者均应行二次根治性切除。
