Department of Hepatobiliary Surgery, First Affiliated Hospital of Wenzhou Medical University, Nanbaixiang Street, Ouhai District, Wenzhou, Zhejiang, China.
BMC Surg. 2021 Jan 23;21(1):59. doi: 10.1186/s12893-021-01068-8.
Gallbladder cancer is a rare but highly malignant cancer, which often progresses to a metastatic stage when diagnosed because of its asymptomatic manifestation. In this study, we intended to analyze the prognostic value of metastatic gallbladder adenocarcinoma (GBA) with site-specific metastases.
Using the Surveillance, Epidemiology, and End Results (SEER) database, GBA patients diagnosed with metastases between 2010 and 2016 were selected to identify the prognosis according to the isolated metastatic sites, including liver, lung, bone, brain and distant lymph nodes (DL). Kaplan-Meier methods were used for survival comparisons and multivariable Cox regression models were constructed to find out independent factors that associated with survival.
Data from 1526 eligible patients were extracted from the SEER database. Among the patients, 788 (51.6%) had isolated liver metastases, 80 (5.2%) had isolated distant nodal involvement, 45 (2.9%) had isolated lung metastases, 21 (1.4%) had isolated bone metastases, 2 (0.1%) had isolated brain metastases and 590 (38.7%) had multiple metastases. No significant survival difference was shown between patients with single or multisite metastases (P > 0.05). Patients with isolated lung or DL metastases had significant better survival outcomes than those with isolated bone metastases (P < 0.05). Multivariate analysis showed that performing surgery at primary site, receiving chemotherapy were associated with better OS and CSS for patients with isolated liver or DL metastases.
The study showed that different metastatic sites affect survival outcomes in metastatic GBA patients. Highly selected subset of patients with liver or DL metastases might benefit from surgery at primary site.
胆囊癌是一种罕见但高度恶性的癌症，由于其无症状表现，通常在诊断时已进展为转移阶段。在这项研究中，我们旨在分析具有特定转移部位的转移性胆囊腺癌（GBA）的预后价值。
使用监测、流行病学和最终结果（SEER）数据库，选择 2010 年至 2016 年间诊断为转移的 GBA 患者，根据孤立性转移部位（包括肝、肺、骨、脑和远处淋巴结（DL））确定预后。采用 Kaplan-Meier 方法进行生存比较，并构建多变量 Cox 回归模型，以找出与生存相关的独立因素。
从 SEER 数据库中提取了 1526 名符合条件的患者数据。在这些患者中，788 名（51.6%）有孤立性肝转移，80 名（5.2%）有孤立性远处淋巴结受累，45 名（2.9%）有孤立性肺转移，21 名（1.4%）有孤立性骨转移，2 名（0.1%）有孤立性脑转移，590 名（38.7%）有多发性转移。单一或多部位转移的患者之间的生存差异无统计学意义（P>0.05）。与孤立性骨转移患者相比，孤立性肺或 DL 转移患者的生存结局显著更好（P<0.05）。多变量分析显示，对原发部位进行手术和接受化疗与孤立性肝或 DL 转移患者的 OS 和 CSS 改善相关。
该研究表明，不同的转移部位影响转移性 GBA 患者的生存结局。具有肝或 DL 转移的高度选择亚组患者可能受益于原发部位的手术。
