Singh Santosh Kumar, Talwar Rajnish, Kannan Narayanan, Tyagi Arvind Kumar, Jaiswal Pradeep, Kumar Adarsh
Department Surgical Oncology, Army Hospital (Research & Referral), New Delhi, 110010, India.
Department Surgical Oncology, Command Hospital (SC), Pune, 411040, India.
J Gastrointest Cancer. 2018 Sep;49(3):268-274. doi: 10.1007/s12029-017-9940-y.
India has high incidence of gallbladder carcinoma with regional variation in incidence, the highest in Northern India. This study examines the patterns of presentation, treatment strategies, and survival rate of all patients with gallbladder cancer (GBC) evaluated at our tertiary academic hospital over a period of 2 years.
All patients presented to our institute with established tissue diagnosis of carcinoma gallbladder were accrued in our study over a time period of 2 years. Presentation, treatment modalities, and survival rates were analyzed.
One hundred six patients were included: 80 females and 26 males (F: M = 3:1). Median age was 60 years. Eighty patients (75%) had gallstones and 20 patients (21%) had typical history of chronic cholecystitis. The common symptom and sign at presentation were pain in the right upper abdomen (81%) and lump abdomen (49%), respectively. Overall resectability rate was 19.8% (21/106). Eighty-five patients were unresectable or metastatic and treated with palliative intent. Stagewise distribution at diagnosis was stage I (0%), stage II (4%), stage IIIA (10%), stage IIIB (8%), stage IVA (17%), and stage IVB (61%). Estimated 1-year survival for stages II, IIIA, IIIB, IVA, and IVB was 100, 76, 47.4, 26, and 10.6%, respectively. Significant difference in OS was observed among different stages of GBC (p value <0.001).
If proper investigations are done, radical surgery including multi-organ resection can be curative with acceptable morbidity and mortality. Stage at presentation and ability to perform curative resection are the most important prognostic factors predicting survival. Palliative chemotherapy should be considered for metastatic GBC.
印度胆囊癌发病率较高，且发病率存在地区差异，印度北部发病率最高。本研究调查了在我们的三级学术医院接受评估的所有胆囊癌（GBC）患者在2年期间的临床表现模式、治疗策略和生存率。
在2年的时间里，我们纳入了所有到我院就诊且经组织学确诊为胆囊癌的患者。分析了患者的临床表现、治疗方式和生存率。
共纳入106例患者，其中女性80例，男性26例（女∶男 = 3∶1）。中位年龄为60岁。80例（75%）患者有胆结石，20例（21%）患者有典型的慢性胆囊炎病史。就诊时常见的症状和体征分别是右上腹疼痛（81%）和腹部肿块（49%）。总体可切除率为19.8%（21/106）。85例患者不可切除或已发生转移，接受了姑息性治疗。诊断时的分期分布为：I期（0%）、II期（4%）、IIIA期（10%）、IIIB期（8%）、IVA期（17%）和IVB期（61%）。II期、IIIA期、IIIB期、IVA期和IVB期患者的估计1年生存率分别为100%、76%、47.4%、26%和10.6%。GBC不同分期之间的总生存期存在显著差异（p值<0.001）。
如果进行适当的检查，包括多器官切除的根治性手术可以治愈疾病，且发病率和死亡率在可接受范围内。就诊时的分期和进行根治性切除的能力是预测生存的最重要预后因素。对于转移性GBC应考虑姑息化疗。
