切除胆囊癌肿瘤位置对预后的影响：全国队列分析。
Prognostic impact of tumor location in resected gallbladder cancer: A national cohort analysis.
机构信息
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, National Institute of Health, Bethesda, Maryland.
出版信息
J Surg Oncol. 2020 Nov;122(6):1084-1093. doi: 10.1002/jso.26107. Epub 2020 Jul 11.
BACKGROUND AND OBJECTIVES
Tumor location (peritoneal vs hepatic) has been incorporated in the 8th edition of the American Joint Committee on Cancer Staging system for gallbladder cancer. However, larger studies are needed to confirm the prognostic impact of tumor location.
METHODS
Patients with pathologically-confirmed gallbladder cancer with information on primary tumor location were included from the National Cancer Database (2009-2012). We compared patients with hepatic-side tumors to those on the peritoneal side. Survival data were plotted using the Kaplan-Meier method. Prognostic factors were modeled with a multivariate Cox Proportional Hazards Model. Primary outcome was overall survival (OS).
RESULTS
A total of 1251 patients were included. In comparison to patients with peritoneal-sided tumors, patients with hepatic-sided tumors were more likely to: be of higher pT stage (pT3: 49% vs 24%; P < .001); node positive (31% vs 24%; P = .016); undergo liver resection (53% vs 25%; P < .001); or have positive margins (29% vs 16%; P < .001). However, on multivariate analysis, there was no difference in OS between the groups (HR, 0.97; 95% CI, 0.79-1.18; P = .753). Liver resection was associated with improved survival regardless of tumor location in pT2 tumors (peritoneal: HR, 0.57; P = .034; hepatic: HR, 0.67; P < .001).
CONCLUSIONS
This study failed to demonstrate the independent prognostic value of primary tumor location in patients with gallbladder cancer.
背景与目的
肿瘤位置（腹膜与肝）已被纳入第 8 版美国癌症联合委员会癌症分期系统用于胆囊癌。然而，需要更大的研究来证实肿瘤位置的预后影响。
方法
本研究纳入了国家癌症数据库（2009-2012 年）中经病理证实的胆囊癌患者，这些患者的主要肿瘤位置信息均可用。我们将肝侧肿瘤患者与腹膜侧肿瘤患者进行比较。采用 Kaplan-Meier 方法绘制生存数据。使用多变量 Cox 比例风险模型对预后因素进行建模。主要结局是总生存（OS）。
结果
共纳入 1251 例患者。与腹膜侧肿瘤患者相比，肝侧肿瘤患者更有可能：处于更高的 pT 分期（pT3：49%比 24%；P<0.001）；淋巴结阳性（31%比 24%；P=0.016）；接受肝切除术（53%比 25%；P<0.001）；或边缘阳性（29%比 16%；P<0.001）。然而，多变量分析显示两组间 OS 无差异（HR，0.97；95%CI，0.79-1.18；P=0.753）。无论肿瘤位置如何，在 pT2 肿瘤中，肝切除术均与生存改善相关（腹膜侧：HR，0.57；P=0.034；肝侧：HR，0.67；P<0.001）。
结论
本研究未能证明胆囊癌患者原发肿瘤位置具有独立的预后价值。
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