Higuchi Ryota, Yazawa Takehisa, Uemura Shuichirou, Matsunaga Yutaro, Ota Takehiro, Araida Tatsuo, Furukawa Toru, Yamamoto Masakazu
Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162-8666, Japan.
Department of Surgery, Ebara Hospital, 4-5-10 Higashiyukigaya, Ota-ku, Tokyo 145-0065, Japan.
Cancers (Basel). 2020 Jul 27;12(8):2073. doi: 10.3390/cancers12082073.
In advanced gallbladder cancer (GBC) radical resection, if multiple prognostic factors are present, the outcome may be poor; however, the details remain unclear. To investigate the poor prognostic factors affecting long-term surgical outcome, we examined 157 cases of resected stage 3/4 GBC without distant metastasis between 1985 and 2017. Poor prognostic factors for overall survival and treatment outcomes of a number of predictable preoperative poor prognostic factors were evaluated. The surgical mortality was 4.5%. In multivariate analysis, blood loss, poor histology, liver invasion, and ≥4 regional lymph node metastases (LNMs) were independent prognostic factors for poor surgical outcomes; invasion of the left margin or the entire area of the hepatoduodenal ligament and a Clavien-Dindo classification ≥3 were marginal factors. The analysis identified outcomes of patients with factors that could be predicted preoperatively, such as liver invasion ≥5 mm, invasion of the left margin or the entire area of the hepatoduodenal ligament, and ≥4 regional LNMs. Thus, the five-year overall survival was 54% for zero factors, 34% for one factor, and 4% for two factors ( < 0.05). A poor surgical outcome was likely when two or more factors were predicted preoperatively; therefore, new treatment strategies are required for such patients.
在晚期胆囊癌（GBC）根治性切除术中，如果存在多种预后因素，结果可能较差；然而，具体情况仍不清楚。为了研究影响长期手术结果的不良预后因素，我们检查了1985年至2017年间157例无远处转移的3/4期GBC切除病例。对一些可预测的术前不良预后因素的总生存和治疗结果的不良预后因素进行了评估。手术死亡率为4.5%。在多变量分析中，失血、组织学差、肝侵犯以及≥4个区域淋巴结转移（LNMs）是手术结果不良的独立预后因素；左缘或肝十二指肠韧带整个区域的侵犯以及Clavien-Dindo分类≥3是边缘因素。该分析确定了术前可预测因素患者的结果，如肝侵犯≥5mm、左缘或肝十二指肠韧带整个区域的侵犯以及≥4个区域LNMs。因此，零因素患者的五年总生存率为54%，一个因素患者为34%，两个因素患者为4%（<0.05）。术前预测有两个或更多因素时，手术结果可能较差；因此，此类患者需要新的治疗策略。
