Department of Surgery, Onomichi General Hospital, Onomichi, Hiroshima, Japan.
Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
Ann Surg Oncol. 2018 Jun;25(6):1699-1708. doi: 10.1245/s10434-018-6444-3. Epub 2018 Apr 6.
The optimal prognostic predictive system for gallbladder carcinoma (GBC) has not been established. The gallbladder cancer predictive risk score (GBRS) based on pathological findings identifies incidental GBC patients at risk of recurrence.
We aimed to validate the prognostic ability of the GBRS in all GBC patients following curative surgery.
Fifty-six patients with GBC who underwent curative surgery between 1996 and 2016 were included in this study. Univariate and multivariate analyses were performed to determine prognostic factors associated with overall and recurrence-free survival, and propensity score-matched analysis was performed.
The median patient age was 71.9 years, and 39.3% of patients were males. All patients underwent curative surgery (33.9%, simple cholecystectomy; 66.1%, more advanced procedures, such as hepatectomy; and 32.1%, bile duct reconstruction). On univariate analysis, preoperative carbohydrate antigen 19-9 (CA19-9) ≥ 37 U/mL (p = 0.042), postoperative complications (p = 0.043), and a high GBRS (p < 0.001) were prognostic factors for worse overall survival. On multivariate analysis, CA19-9 ≥ 37 U/mL (p = 0.039 and p = 0.043, respectively) and a high GBRS (p = 0.001 and p = 0.010, respectively) were independent risk factors for poor overall and recurrence-free survival. After propensity score-matched analysis, the GBRS precisely predicted prognosis of patients with GBC.
The GBRS is an easy and novel prognostic predicting score. Our validation revealed good discrimination, suggesting its clinical utility to improve individualized prediction of survival for patients undergoing resection of GBC.
目前尚未建立用于胆囊癌（GBC）的最佳预后预测系统。基于病理发现的胆囊癌预测风险评分（GBRS）可识别有复发风险的偶然 GBC 患者。
我们旨在验证该评分系统在所有接受根治性手术的 GBC 患者中的预后能力。
本研究纳入了 1996 年至 2016 年间接受根治性手术的 56 例 GBC 患者。进行单因素和多因素分析，以确定与总生存和无复发生存相关的预后因素，并进行倾向评分匹配分析。
患者的中位年龄为 71.9 岁，39.3%为男性。所有患者均接受根治性手术（33.9%为单纯胆囊切除术；66.1%为更高级别的手术，如肝切除术；32.1%为胆管重建术）。单因素分析显示，术前糖类抗原 19-9（CA19-9）≥37 U/mL（p=0.042）、术后并发症（p=0.043）和高 GBRS（p<0.001）是总生存较差的预后因素。多因素分析显示，CA19-9≥37 U/mL（分别为 p=0.039 和 p=0.043）和高 GBRS（分别为 p=0.001 和 p=0.010）是总生存和无复发生存较差的独立危险因素。在倾向评分匹配分析后，GBRS 准确预测了 GBC 患者的预后。
GBRS 是一种简单且新颖的预后预测评分。我们的验证表明其具有良好的区分度，提示其在改善 GBC 患者生存的个体化预测方面具有临床应用价值。
