Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
Christus Trinity Mother Frances Hospital, Tyler, TX, USA.
Ann Surg Oncol. 2019 Feb;26(2):604-610. doi: 10.1245/s10434-018-7064-7. Epub 2018 Nov 29.
Current guidelines recommend radical cholecystectomy with regional lymphadenectomy (RC-RL) for patients with T1b gallbladder cancer (GBC). However, the extent to which these guidelines are followed is unclear. This study aimed to evaluate current surgical practices for T1b GBC and their implications for overall management strategies and associated outcomes.
This retrospective cohort study investigated patients identified from the National Cancer Data Base (2004-2012) with non-metastatic T1b GBC. The patients were categorized according to type of surgical treatment received: simple cholecystectomy (SC) or RC-RL. Among the patients who had lymph nodes pathologically examined, nodal status was classified as pN- or pN+. Use of any adjuvant therapy was ascertained. Overall survival (OS) was compared based on type of surgical treatment and nodal status.
The cohort comprised 464 patients (247 SC and 217 RC-RL cases). The positive margin status did not differ between the two groups (6.1% for SC vs 2.3% for RC-RL; p = 0.128). For RC-RL, the pN+ rate was 15%. Adjuvant therapies were used more frequently in pN+ (53.1% vs 9.4% for pN-). By comparison, 10.9% of the SC patients received adjuvant therapy. The OS for RC-RL-pN- (5-years OS, 64.4%) was significantly better than for RC-RL-pN+ (5-years OS, 15.7%) or SC (5-years OS, 48.3%) (p < 0.001).
Less than 50% of the patients with a T1b GBC primary tumor undergo the recommended surgical treatment. Given that 15% of these patients have nodal metastasis and in light of the previously described benefits of adjuvant therapy for node positive GBC, failure to perform RC-RL risks incomplete staging and thus undertreatment for patients with T1b GBC.
目前的指南建议对 T1b 期胆囊癌（GBC）患者行根治性胆囊切除术加区域淋巴结清扫术（RC-RL）。然而，这些指南的实施程度尚不清楚。本研究旨在评估 T1b GBC 的当前手术治疗方法及其对整体管理策略和相关结局的影响。
本回顾性队列研究调查了国家癌症数据库（2004-2012 年）中诊断为非转移性 T1b GBC 的患者。根据接受的手术治疗类型将患者分为单纯胆囊切除术（SC）或 RC-RL。对接受病理检查淋巴结的患者，淋巴结状态分为 pN-或 pN+。确定是否使用任何辅助治疗。根据手术治疗类型和淋巴结状态比较总生存期（OS）。
该队列包括 464 名患者（SC 组 247 例，RC-RL 组 217 例）。两组的阳性切缘状态无差异（SC 组为 6.1%，RC-RL 组为 2.3%；p=0.128）。对于 RC-RL，pN+的比例为 15%。pN+患者更常使用辅助治疗（53.1%比 pN-患者的 9.4%）。相比之下，10.9%的 SC 患者接受了辅助治疗。RC-RL-pN-（5 年 OS，64.4%）的 OS 明显优于 RC-RL-pN+（5 年 OS，15.7%）或 SC（5 年 OS，48.3%）（p<0.001）。
不到 50%的 T1b GBC 患者接受了推荐的手术治疗。鉴于这些患者中有 15%存在淋巴结转移，且先前描述的淋巴结阳性 GBC 辅助治疗获益，RC-RL 未实施会导致分期不完整，从而对 T1b GBC 患者治疗不足。
