Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio.
Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
J Surg Oncol. 2020 Mar;121(3):503-510. doi: 10.1002/jso.25825. Epub 2020 Jan 6.
The survival benefit of lymphadenectomy among patients with gallbladder cancer (GBC) remains poorly understood.
Patients who underwent resection for GBC between 2000 and 2015 were identified from a US multi-institutional database. The therapeutic index (LNM rate multiplied by 3-year overall survival [OS]) was determined to assess the survival benefit of lymphadenectomy.
Among 449 patients, less than half had LNM (N = 183, 40.8%). The median number of evaluated and metastatic lymph nodes (LNs) was 3 (interquartile range [IQR]: 1-6) and 1 (IQR: 0-1), respectively. 3-year OS among patients with LNM in the entire cohort was 26.8%. The therapeutic index was lower among patients with T4 (5.9) or T1 (6.0) tumors as well as carbohydrate antigen (CA19-9) ≥200 UI/mL (6.0). Of note, a therapeutic index difference ≥10 was noted relative to CA19-9 (<200: 18.7 vs ≥200: 6.0), American Joint Committee on Cancer T Stage (T1: 6.0 vs T2: 17.8 vs T4: 5.9) and number of LNs examined (1-2: 6.9 vs ≥6: 16.9). Concomitant common bile duct resection was not associated with a higher therapeutic index among patients with either T2 or T3 disease.
Certain clinicopathological factors including T1 or T4 tumor and CA19-9 ≥200 UI/mL were associated with a low therapeutic index. Resection of six or more LNs was associated with a meaningful therapeutic index benefit among patients with LNM.
胆囊癌（GBC）患者行淋巴结清扫术的生存获益仍不清楚。
从美国多机构数据库中确定了 2000 年至 2015 年间接受 GBC 切除术的患者。通过确定治疗指数（LNM 率乘以 3 年总生存率 [OS]）来评估淋巴结清扫术的生存获益。
在 449 名患者中，不到一半的患者发生 LNM（N=183，40.8%）。评估和转移性淋巴结（LNs）的中位数数量分别为 3（四分位距 [IQR]：1-6）和 1（IQR：0-1）。整个队列中 LNM 患者的 3 年 OS 为 26.8%。T4（5.9）或 T1（6.0）肿瘤以及肿瘤标志物 CA19-9≥200 UI/mL（6.0）患者的治疗指数较低。值得注意的是，与 CA19-9（<200：18.7 vs ≥200：6.0）、美国癌症联合委员会 T 分期（T1：6.0 vs T2：17.8 vs T4：5.9）和检查的 LNs 数量（1-2：6.9 vs ≥6：16.9）相比，治疗指数差异≥10。对于 T2 或 T3 疾病患者，同时行胆总管切除术与较高的治疗指数无关。
某些临床病理因素，包括 T1 或 T4 肿瘤和 CA19-9≥200 UI/mL，与低治疗指数相关。在有 LNM 的患者中，切除 6 个或更多的 LNs 与显著的治疗指数获益相关。
