Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, 1-757 Asahimachi-dori, Chuo-ku, Niigata City, Niigata, 951-8510, Japan.
Langenbecks Arch Surg. 2021 May;406(3):801-811. doi: 10.1007/s00423-020-02068-7. Epub 2021 Jan 4.
Outcomes following surgery for advanced gallbladder carcinoma remain unsatisfactory. This study aimed to determine the surgical outcome and effectiveness of adjuvant chemotherapy according to TNM stage in patients with gallbladder carcinoma.
A total of 200 patients undergoing surgery for gallbladder carcinoma were enrolled. Clinicopathological data were evaluated and surgical outcomes were compared between patients with and without adjuvant chemotherapy according to TNM stage.
The 5-year overall survival (OS) after resection for patients with stage I (n = 27), IIA (n = 18), IIB (n = 28), IIIA (n = 25), IIIB (n = 43), IVA (n = 7), and IVB (n = 52) disease was 90.8%, 94.4%, 73.6%, 33.7%, 57.7%, 14.3%, and 11.8%, respectively (p < 0.001). R0 resection was performed in all patients with stage I or II disease, in 89.7% of those with stage III disease, and 69.5% of those with stage IV disease. For patients with stage III disease, adjuvant chemotherapy was associated with improved OS (5-year OS, 60.9% vs. 41.1%; p = 0.028) and was an independent prognostic factor (hazard ratio, 2.045; p = 0.039). For patients with stage IV disease, adjuvant chemotherapy appeared to affect OS (5-year OS, 25.1% vs. 5.3%; p = 0.041); R0 resection (hazard ratio, 1.882; p = 0.040) was the only independent prognostic factor.
TNM stage clearly predicts survival after resection of gallbladder carcinoma. R0 resection with adjuvant chemotherapy is recommended for long-term survival in the multimodal management of patients with stage III or IV gallbladder carcinoma.
晚期胆囊癌患者手术后的预后仍不理想。本研究旨在根据 TNM 分期确定胆囊癌患者手术的结果和辅助化疗的疗效。
共纳入 200 例接受胆囊癌手术的患者。评估临床病理数据，并根据 TNM 分期比较有和无辅助化疗患者的手术结果。
I 期（n=27）、IIA 期（n=18）、IIB 期（n=28）、IIIA 期（n=25）、IIIB 期（n=43）、IVA 期（n=7）和 IVB 期（n=52）患者切除术后的 5 年总生存率（OS）分别为 90.8%、94.4%、73.6%、33.7%、57.7%、14.3%和 11.8%（p<0.001）。所有 I 期或 II 期疾病患者均行 R0 切除，III 期疾病患者中 89.7%，IV 期疾病患者中 69.5%行 R0 切除。对于 III 期疾病患者，辅助化疗与 OS 改善相关（5 年 OS，60.9% vs. 41.1%；p=0.028），是独立的预后因素（风险比，2.045；p=0.039）。对于 IV 期疾病患者，辅助化疗似乎影响 OS（5 年 OS，25.1% vs. 5.3%；p=0.041）；R0 切除（风险比，1.882；p=0.040）是唯一独立的预后因素。
TNM 分期明确预测胆囊癌切除术后的生存。在 III 期或 IV 期胆囊癌的多模式管理中，建议行 R0 切除并辅助化疗以获得长期生存。
