偶然与非偶然胆囊癌：在 T2b 肿瘤中，术前意外胆囊癌行指数性胆囊切除术对肿瘤再次切除后的生存有负面影响。
Incidental versus non-incidental gallbladder cancer: index cholecystectomy before oncologic re-resection negatively impacts survival in T2b tumors.
机构信息
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA; Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile.
Department of Digestive Surgery, Hepato-Bilio-Pancreatic Surgery Unit, Surgery Service, Sotero Del Rio Hospital, Puente Alto, Chile; Department of Digestive Surgery, Faculty of Medicine, Catholic University of Chile, Santiago, Chile.
出版信息
HPB (Oxford). 2019 Aug;21(8):1046-1056. doi: 10.1016/j.hpb.2018.12.006. Epub 2019 Jan 31.
BACKGROUND
Conflicting data exists whether non-oncologic index cholecystectomy (IC) leading to discovery of incidental gallbladder cancer (IGBC) negatively impacts survival. This study aimed to determine whether a subgroup of patients derives a disadvantage from IC.
METHODS
Patients with IGBC and non-IGBC treated at an academic USA and Chilean center during 1999-2016 were compared. Patients with T1, T4 tumor or preoperative jaundice were excluded. T2 disease was classified into T2a (peritoneal-side tumor) and T2b (hepatic-side tumor). Disease-specific survival (DSS) and its predictors were analyzed.
RESULTS
Of the 196 patients included, 151 (77%) had IGBC. One hundred thirty-six (90%) patients of whom 118 (87%) had IGBC had T2 disease. Three-year DSS rates were similar between IGBC and non-IGBC for all patients. However, for T2b patients, 3-year survival rate was worse for IGBC (31% vs 85%; p = 0.019). In multivariate analysis of T2 patients, predictors of poor DSS were hepatic-side tumor hazard ratio [HR], 2.9; 95% CI, 1.6-5.4; p = 0.001) and N1 status (HR, 2.4; 95% CI, 1.6-3.6; p < 0.001).
CONCLUSIONS
Patients with T2b gallbladder cancer specifically benefit from a single operation. These patients should be identified preoperatively and referred to hepatobiliary center.
背景
是否非肿瘤性胆囊切除术（IC）导致偶然发现的胆囊癌（IGBC）会对生存产生负面影响，目前存在相互矛盾的数据。本研究旨在确定是否存在一个亚组患者因 IC 而处于不利地位。
方法
比较了 1999 年至 2016 年在美国和智利的一家学术中心治疗的 IGBC 和非 IGBC 患者。排除了 T1、T4 肿瘤或术前黄疸患者。T2 疾病分为 T2a（腹膜侧肿瘤）和 T2b（肝侧肿瘤）。分析了疾病特异性生存（DSS）及其预测因素。
结果
196 例患者中，151 例（77%）为 IGBC。其中 136 例（90%）患者中有 T2 疾病，其中 118 例（87%）为 IGBC。所有患者的 IGBC 和非 IGBC 的 3 年 DSS 率相似。然而，对于 T2b 患者，IGBC 的 3 年生存率更差（31%比 85%；p=0.019）。在 T2 患者的多变量分析中，DSS 不良的预测因素为肝侧肿瘤危险比[HR]，2.9；95%置信区间，1.6-5.4；p=0.001）和 N1 状态（HR，2.4；95%置信区间，1.6-3.6；p<0.001）。
结论
特定的 T2b 胆囊癌患者从单次手术中获益。这些患者应在术前识别，并转至肝胆中心。
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