Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226, USA.
Dig Dis Sci. 2013 Sep;58(9):2455-62. doi: 10.1007/s10620-013-2713-y. Epub 2013 May 22.
The 5-year survival of patients with gallbladder cancer remains low. However, patients can be stratified into prognostic categories based on established factors such as T, N, and R status. New concepts regarding prognostic significance of lymph node disease, the importance of residual gallbladder fossa disease, and the gravity of presentation with jaundice are reviewed. In addition, a number of new prognostic factors proposed in recent years are considered.
PubMed was searched for "gallbladder cancer" with builder "date-completion" 2008 to present. A total of 1,490 articles were screened from which 168 were retrieved. From this, 40 articles specifically related to prognosis form the basis for this review.
Key factors of prognostic significance remain T and N stage and R0 resection. Residual disease either in the gallbladder fossa, lymph nodes, or cystic duct margin dictates hepatectomy, lymphadenectomy and bile duct resection, respectively. Adequate lymphadenectomy requires removal of six nodes, and hepatectomy must be sufficient to achieve R0. Subtleties regarding lymph node ratio, significance of pathological features such as dedifferentiation, and budding may hold value for stratifying patients with early stage disease, but require further investigation.
胆囊癌患者的 5 年生存率仍然较低。然而，患者可以根据 T、N 和 R 状态等既定因素分为预后类别。本文回顾了关于淋巴结疾病预后意义、残余胆囊窝疾病重要性以及黄疸表现严重性的新概念，以及近年来提出的一些新的预后因素。
在 PubMed 上使用“date-completion”搜索“gallbladder cancer”，范围为 2008 年至今。从总共筛选出的 1490 篇文章中，检索到了 168 篇文章。其中，有 40 篇专门讨论了预后问题，是本综述的基础。
预后意义的关键因素仍然是 T 和 N 分期以及 RO 切除。残余的胆囊窝、淋巴结或胆囊管切缘疾病分别需要行肝切除术、淋巴结清扫术和胆管切除术。充分的淋巴结清扫需要切除 6 个淋巴结，肝切除术必须足以达到 RO。淋巴结比率、去分化等病理特征的意义以及芽生等细微问题可能对分层早期疾病患者具有价值，但需要进一步研究。
