Department of General Surgery, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191, PR China.
Eur J Surg Oncol. 2020 Nov;46(11):2099-2105. doi: 10.1016/j.ejso.2020.07.006. Epub 2020 Jul 28.
Surgical resection has been proposed for curable gallbladder cancer (GBCA); however, optimal preoperative evaluation and resection planning methods remain unestablished. The aim of this study was to establish the types of CT tumour radiological appearances in GBCA with a focus on its association with clinicopathologic features and its prognostic impact in curable GBCA.
In all, 118 patients surgically treated for GBCA were identified and CT tumour radiological appearances were reviewed. Models were established and internally validated. Clinicopathologic variables and prognostic impact were analysed for correlation with tumour radiological appearance.
The classification and distribution of tumour radiological appearance in these patients was Type 1 (n = 14), Type 2 (n = 60), Type 3 (n = 21), Type 4 (n = 18), and undetermined (n = 5). Among the 113 patients, a higher tendency of T stage and incidence of lymph node metastasis was observed from Type 1 to Type 4. Most Type 1 patients were T1 stage, they have no lymph node involvement or recurrence. With a median follow-up of 25 months (range, 1-135 months), a clear prognostic difference was observed among the 4 types after surgical treatment (p < 0.001). Type 1 patients showed 100% 5-year survival rate. Among the 66 T2 tumours, both tumour location and tumour radiological appearance effectively stratified patient prognosis (p < 0.001, p = 0.007). Introducing tumour radiological appearance into tumour location enabled further prognostic stratification of the 35 T2h tumours (p < 0.001).
Type of CT tumour radiological appearance is a predictor of tumour biology. It may improve preoperative evaluation and resection planning.
手术切除被提议用于可治愈的胆囊癌（GBCA）；然而，最佳的术前评估和切除规划方法仍未建立。本研究的目的是确定 GBCA 的 CT 肿瘤影像学表现类型，重点关注其与临床病理特征的关系及其对可治愈 GBCA 的预后影响。
共确定了 118 例接受 GBCA 手术治疗的患者，并对其 CT 肿瘤影像学表现进行了回顾性分析。建立并内部验证了模型。分析了临床病理变量和预后与肿瘤影像学表现的相关性。
这些患者的肿瘤影像学表现分类和分布为：Type 1（n=14）、Type 2（n=60）、Type 3（n=21）、Type 4（n=18）和未确定（n=5）。在 113 例患者中，从 Type 1 到 Type 4，T 分期和淋巴结转移发生率的趋势更高。大多数 Type 1 患者为 T1 期，无淋巴结受累或复发。中位随访时间为 25 个月（范围为 1-135 个月），手术后 4 种类型的患者预后有明显差异（p<0.001）。Type 1 患者的 5 年生存率为 100%。在 66 例 T2 肿瘤中，肿瘤位置和肿瘤影像学表现均能有效地分层患者的预后（p<0.001，p=0.007）。将肿瘤影像学表现引入肿瘤位置后，可进一步对 35 例 T2h 肿瘤进行预后分层（p<0.001）。
CT 肿瘤影像学表现类型是肿瘤生物学的预测指标。它可以改善术前评估和切除规划。
