Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, 8-1, Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan.
Department of Hepatobiliary and Pancreatic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
BMC Gastroenterol. 2022 Mar 28;22(1):152. doi: 10.1186/s12876-022-02234-9.
Gallbladder cancer (GBC) with liver metastasis is considered unresectable. However, there have been infrequent reports of long-term survival in patients with GBC and liver metastases. Therefore, we examined the characteristics of long-term survivors of gallbladder cancer with liver metastasis.
A retrospective multicenter study of 462 patients with GBC (mean age, 71 years; female, 51%) was performed. Although patients with pre-operatively diagnosed GBC and liver metastasis were generally excluded from resection, some cases identified during surgery were resected.
In patients with resected stage III/IV GBC (n = 193), the period 2007-2013 (vs. 2000-2006, hazard ratio 0.63), pre-operative jaundice (hazard ratio 1.70), ≥ 2 liver metastases (vs. no liver metastasis, hazard ratio 2.11), and metastasis to the peritoneum (vs. no peritoneal metastasis, hazard ratio 2.08) were independent prognostic factors for overall survival, whereas one liver metastasis (vs. no liver metastasis) was not. When examining the 5-year overall survival and median survival times by liver metastasis in patients without peritoneal metastasis or pre-operative jaundice, those with one liver metastasis (63.5%, not reached) were comparable to those without liver metastasis (40.4%, 33.0 months), and was better than those with ≥ 2 liver metastases although there was no statistical difference (16.7%, 9.0 months). According to the univariate analysis of resected patients with GBC and liver metastases (n = 26), minor hepatectomy, less blood loss, less surgery time, papillary adenocarcinoma, and T2 were significantly associated with longer survival. Morbidity of Clavien-Dindo classification ≤ 2 and received adjuvant chemotherapy were marginally not significant. Long-term survivors (n = 5) had a high frequency of T2 tumors (4/5), had small liver metastases near the gallbladder during or after surgery, underwent minor hepatectomy without postoperative complications, and received postoperative adjuvant chemotherapy.
Although there is no surgical indication for GBC with liver metastasis diagnosed pre-operatively, minor hepatectomy and postoperative chemotherapy may be an option for selected patients with T2 GBC and liver metastasis identified during or after surgery who do not have other poor prognostic factors.
伴有肝转移的胆囊癌（GBC）被认为无法切除。然而，有少数 GBC 伴肝转移患者长期生存的报道。因此，我们研究了伴有肝转移的长期生存胆囊癌患者的特征。
对 462 例 GBC 患者（平均年龄 71 岁；女性占 51%）进行回顾性多中心研究。尽管术前诊断为 GBC 伴肝转移的患者一般不排除手术切除，但术中发现的某些病例进行了切除。
在接受手术切除的 III/IV 期 GBC 患者（n=193）中，2007-2013 年期间（与 2000-2006 年相比，风险比 0.63）、术前黄疸（风险比 1.70）、≥2 个肝转移灶（与无肝转移灶相比，风险比 2.11）和腹膜转移（与无腹膜转移相比，风险比 2.08）是总生存的独立预后因素，而 1 个肝转移灶（与无肝转移灶相比）不是。在无腹膜转移或术前黄疸的患者中，根据肝转移的 5 年总生存率和中位生存时间进行检查，1 个肝转移灶（63.5%，未达到）与无肝转移灶（40.4%，33.0 个月）相当，且优于≥2 个肝转移灶（尽管无统计学差异）（16.7%，9.0 个月）。根据 26 例手术切除的 GBC 伴肝转移患者的单因素分析，肝段切除术、出血量少、手术时间短、乳头状腺癌和 T2 期与生存时间延长显著相关。Clavien-Dindo 分级≤2 的发病率和接受辅助化疗则为边缘性无显著性差异。5 例长期生存者（n=5）T2 肿瘤的频率较高（4/5），手术时或手术后胆囊附近的肝转移灶较小，无术后并发症行肝段切除术，术后接受辅助化疗。
尽管术前诊断为伴有肝转移的 GBC 无手术指征，但对于术中或术后发现无其他不良预后因素的 T2 GBC 伴肝转移患者，肝段切除术和术后化疗可能是一种选择。
