Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA.
Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA.
Virchows Arch. 2021 May;478(5):875-884. doi: 10.1007/s00428-020-02968-5. Epub 2021 Jan 7.
Published data on survival of T2 gallbladder carcinoma (GBC) from different countries show a wide range of 5-year survival rates from 30-> 70%. Recently, studies have demonstrated substantial variation between countries in terms of their approach to sampling gallbladders, and furthermore, that pathologists from different continents apply highly variable criteria in determining stage of invasion in this organ. These findings raised the question of whether these variations in pathologic evaluation could account for the vastly different survival rates of T2 GBC reported in the literature. In this study, survival of 316 GBCs from three countries (Chile n = 137, South Korea n = 105, USA n = 74), all adequately sampled (with a minimum of five tumor sections examined) and histopathologically verified as pT2 (after consensus examination by expert pathologists from three continents), was analyzed. Chilean patients had a significantly worse prognosis based on 5-year all-cause mortality (HR: 1.89, 95% CI: 1.27-2.83, p = 0.002) and disease-specific mortality (HR: 2.41, 95% CI: 1.51-3.84, p < 0.001), compared to their South Korean counterparts, even when controlled for age and sex. Comparing the USA to South Korea, the survival differences in all-cause mortality (HR: 1.75, 95% CI: 1.12-2.75, p = 0.015) and disease-specific mortality (HR: 1.94, 95% CI: 1.14-3.31, p = 0.015) were also pronounced. The 3-year disease-specific survival rates in South Korea, the USA, and Chile were 75%, 65%, and 55%, respectively, the 5-year disease-specific survival rates were 60%, 50%, and 50%, respectively, and the overall 5-year survival rates were 55%, 45%, and 35%, respectively. In conclusion, the survival of true T2 GBC in properly classified cases is neither as good nor as bad as previously documented in the literature and shows notable geographic differences even in well-sampled cases with consensus histopathologic criteria. Future studies should focus on other potential reasons including biologic, etiopathogenetic, management-related, populational, or healthcare practice-related factors that may influence the survival differences of T2 GBC in different regions.
已发表的来自不同国家的 T2 胆囊癌（GBC）生存数据显示，5 年生存率范围从 30%到 70%不等。最近，研究表明，在胆囊取样方法方面，各国之间存在很大差异，此外，来自不同大洲的病理学家在确定该器官侵袭阶段时应用了高度可变的标准。这些发现提出了一个问题，即病理评估中的这些差异是否可以解释文献中报道的 T2 GBC 生存率差异很大。在这项研究中，分析了来自三个国家（智利 n = 137、韩国 n = 105、美国 n = 74）的 316 例 GBC 的生存情况，这些 GBC 均经过充分取样（检查了至少 5 个肿瘤切片），并经来自三个大洲的专家病理学家通过共识检查确认为 pT2（经组织病理学验证）。与韩国患者相比，智利患者的预后明显较差，基于 5 年全因死亡率（HR：1.89，95%CI：1.27-2.83，p = 0.002）和疾病特异性死亡率（HR：2.41，95%CI：1.51-3.84，p < 0.001）。与韩国患者相比，即使在控制了年龄和性别因素后，与美国患者相比，智利患者的全因死亡率（HR：1.75，95%CI：1.12-2.75，p = 0.015）和疾病特异性死亡率（HR：1.94，95%CI：1.14-3.31，p = 0.015）的生存差异也更为显著。韩国、美国和智利的 3 年疾病特异性生存率分别为 75%、65%和 55%，5 年疾病特异性生存率分别为 60%、50%和 50%，5 年总生存率分别为 55%、45%和 35%。总之，在经过正确分类的病例中，真正的 T2 GBC 的生存率既没有之前文献中记录的那么好，也没有那么差，即使在采用共识组织病理学标准充分取样的病例中，也存在明显的地域差异。未来的研究应集中于其他潜在原因，包括生物学、病因发病学、管理相关、人群或医疗保健实践相关因素，这些因素可能会影响不同地区 T2 GBC 的生存差异。
