Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital, Santiago, Chile.
Department of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Sotero del Rio Hospital, Santiago, Chile; Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile.
Eur J Surg Oncol. 2019 Jun;45(6):1061-1068. doi: 10.1016/j.ejso.2019.01.013. Epub 2019 Jan 24.
Prognostic factors following index-cholecystectomy in patients with incidental gallbladder cancer (IGBC) are poorly understood. The aim of this study was to assess the value of the initial cystic duct margin status as a prognosticator factor and to aid in clinical decision making to move forward with curative intent oncologic extended resection (OER).
This retrospective study included patients with IGBC who underwent subsequent OER with curative intent at 2 centers (USA and Chile) between 1999 and 2016., Patients with and without evidence of residual cancer (RC) at OER were included. Pathologic features were examined, and predictors of overall survival (OS) were analyzed.
The study included 179 patients. Thirty-three patients (17%) had a positive cystic duct margin at the index cholecystectomy. Forty-two patients (23%) underwent resection of the common bile duct. OS was significantly worse in the patients with a positive cystic duct margin at index cholecystectomy (OS rates at 5 years, 34% vs 57%; p = 0.032). Following multivariate analysis, only a positive cystic duct margin at index cholecystectomy was predictive of worse OS in patients with no evidence of residual cancer (RC) at OER (hazard ratio, 1.7 95%CI 1.04-2.78; p = 0.034).
A positive cystic duct margin at index-cholecystectomy is a strong independent predictor of worse OS even if no further cancer is found at OER. In patients with positive cystic duct margin and no RC at OER common bile duct resection leads to improved outcomes.
偶发胆囊癌（IGBC）患者在接受胆囊切除术指数后的预后因素了解甚少。本研究旨在评估初始胆囊管切缘状态作为预后因素的价值，并为临床决策提供帮助，以进行有治愈意图的肿瘤扩大切除术（OER）。
本回顾性研究纳入了 1999 年至 2016 年期间在 2 个中心（美国和智利）接受后续 OER 治疗且具有治愈意图的 IGBC 患者。包括有和没有 OER 残留癌（RC）证据的患者。检查了病理特征，并分析了总生存（OS）的预测因素。
研究共纳入 179 例患者。33 例（17%）患者在初次胆囊切除术时胆囊管切缘阳性。42 例（23%）患者行胆总管切除术。初次胆囊切除术时胆囊管切缘阳性的患者 OS 明显较差（5 年 OS 率分别为 34%和 57%；p=0.032）。多变量分析后，仅在 OER 无 RC 证据的患者中，初次胆囊切除术时胆囊管切缘阳性是 OS 较差的预测因素（危险比，1.7；95%CI 1.04-2.78；p=0.034）。
即使在 OER 未发现进一步的癌症时，初次胆囊切除术时胆囊管切缘阳性也是 OS 较差的独立强预测因素。在胆囊管切缘阳性且 OER 无 RC 的患者中，行胆总管切除术可改善结局。
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