Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University Hospital, Tokyo, Japan.
Surgery. 2019 Mar;165(3):541-547. doi: 10.1016/j.surg.2018.09.003. Epub 2018 Oct 19.
The treatment approach to node-positive gallbladder cancer has unresolved issues with regard to the management of patients with a positive superior retro-pancreatic (level 13a) node, which is the highest level of spread. The American Joint Committee on Cancer remains unclear on the status of the 13a node.
This retrospective study consisted of 165 patients with node-positive gallbladder cancer without distant metastasis. Patients were reclassified according to the American Joint Committee on Cancer eighth edition classification. The survival of patients with positive level 13a node was compared with that of patients with N1 disease (T stage-wise) and those with para-aortic nodal disease. A multivariate analysis was performed for factors affecting survival.
The 5-year survival of patients with positive level 13a with 1-3 nodes was similar to those with N1 disease (40.2% and 32.9%, respectively) and was better than those with more distant nodal spread (P < .05). In univariate and multivariate analyses, intraoperative blood loss (hazard ratio [HR] 1.58), R1 resection (HR 1.87), and T4 disease (versus T2, HR 3.44) were poor prognosticators. Pancreaticoduodenectomy may be beneficial in T2 patients.
A positive superior retro-pancreatic node does not worsen the prognosis in an otherwise N1 disease in T1/T2 gallbladder cancer. It behaves like a regional lymph node and should be treated as such.
对于阳性胰后（第 13a 水平）淋巴结的患者，即淋巴结转移的最高水平，淋巴结阳性胆囊癌的治疗方法在管理方面仍存在未解决的问题。美国癌症联合委员会（American Joint Committee on Cancer，AJCC）对 13a 淋巴结的状况仍不明确。
本回顾性研究纳入了 165 例无远处转移的淋巴结阳性胆囊癌患者。患者根据 AJCC 第八版分类重新进行分类。比较了阳性第 13a 水平淋巴结患者与 N1 疾病（按 T 分期）患者以及腹主动脉旁淋巴结疾病患者的生存情况。对影响生存的因素进行了多因素分析。
阳性第 13a 水平淋巴结且有 1-3 个淋巴结转移的患者 5 年生存率与 N1 疾病患者相似（分别为 40.2%和 32.9%），优于远处淋巴结转移患者（P<.05）。单因素和多因素分析显示，术中出血量（风险比[HR] 1.58）、R1 切除（HR 1.87）和 T4 疾病（与 T2 相比，HR 3.44）是不良预后因素。对于 T2 患者，胰十二指肠切除术可能有益。
在 T1/T2 胆囊癌中，阳性胰后淋巴结并不使 otherwise N1 疾病的预后恶化。它的行为类似于局部淋巴结，应按照局部淋巴结处理。
