Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan.
Division of Interventional Radiology, Shizuoka Cancer Center, Sunto-Nagaizumi, Shizuoka, Japan.
Ann Surg Oncol. 2022 Sep;29(9):5447-5457. doi: 10.1245/s10434-022-11937-y. Epub 2022 Jun 6.
Surgical resection is the only potentially curative therapy for gallbladder carcinoma (GBC). However, the postoperative recurrence rate is high (approximately 50%), and recurrence occasionally develops early after surgery.
A total of 139 patients who underwent macroscopically curative resection for GBC between 2002 and 2018 were retrospectively reviewed. Early recurrence (ER) was defined as recurrence within 6 months after surgery. Univariate and multivariate logistic regression analysis was performed using preoperative factors that may influence early recurrence, namely patient background factors, tumor markers, imaging findings, and body composition parameters obtained preoperatively, to create a predictive score for ER.
The median follow-up period was 21.9 months (range, 6.2-195.7 months). Postoperative recurrence was observed in 55 (39.6%) patients, of whom 14 (25.5%) developed ER. The median overall survival after surgery was 104.7 months for the non-ER group and 15.7 months for the ER group. On multivariate analysis, high carbohydrate antigen 19-9, low muscle attenuation, high visceral fat attenuation, liver invasion, and other organ invasion on preoperative computed tomography were identified as independent risk factors for ER. A preoperatively predictive scoring system for ER was constructed by weighting the above five factors. The nomogram showed an area under the curve of 0.881, indicating good predictive potential for ER.
ER in resected GBC indicates a very poor prognosis. The present preoperative scoring system can sufficiently predict ER and may be helpful in determining the optimal treatment strategies.
手术切除是治疗胆囊癌（GBC）唯一可能治愈的方法。然而，术后复发率较高（约 50%），且术后复发时间偶尔较早。
回顾性分析了 2002 年至 2018 年间接受胆囊癌根治性切除术的 139 例患者。早期复发（ER）定义为术后 6 个月内复发。采用单因素和多因素逻辑回归分析了可能影响早期复发的术前因素，即患者背景因素、肿瘤标志物、影像学表现和术前获得的身体成分参数，以创建 ER 的预测评分。
中位随访时间为 21.9 个月（范围 6.2-195.7 个月）。术后复发 55 例（39.6%），其中 14 例（25.5%）发生 ER。非 ER 组术后总生存期中位数为 104.7 个月，ER 组为 15.7 个月。多因素分析显示，术前 CA19-9 高、肌肉衰减低、内脏脂肪衰减高、肝侵犯和其他器官侵犯是 ER 的独立危险因素。通过加权上述五个因素构建了 ER 的术前预测评分系统。该列线图显示曲线下面积为 0.881，表明对 ER 具有良好的预测潜力。
切除后的胆囊癌 ER 提示预后极差。本术前评分系统可充分预测 ER，可能有助于确定最佳治疗策略。
