Akabane Miho, Shindoh Junichi, Kohno Kei, Okubo Satoshi, Matsumura Masaru, Takazawa Yutaka, Hashimoto Masaji
Department of Gastroenterological Surgery, Hepatobiliary-Pancreatic Surgery Division, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan.
Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
Langenbecks Arch Surg. 2023 Feb 1;408(1):73. doi: 10.1007/s00423-023-02823-6.
Tumor sidedness (hepatic side vs. peritoneal side) reportedly predicts microvascular invasion and survival outcomes of T2 gallbladder cancer, although the actual histopathological mechanism is not fully understood.
The clinical relevance of tumor sidedness was revisited in 84 patients with gallbladder cancer using histopathological analysis of the vascular density of the gallbladder wall.
Hepatic-side tumor location was associated with overall survival (OS) (hazard ratio [HR], 13.62; 95% confidence interval [CI], 2.09-88.93) and recurrence-free survival (RFS) (HR, 8.70; 95% CI, 1.36-55.69) in T2 tumors. The Adjusted Kaplan-Meier curve indicated a clear survival difference between T2a (peritoneal side) and T2b (hepatic side) tumors (P = 0.006). A review of 56 pathological specimens with gallbladder cancer and 20 control specimens demonstrated that subserosal vascular density was significantly higher on the hepatic side of the gallbladder, regardless of the presence of cancer (P < 0.001). Multivariate analysis also confirmed that higher subserosal vascular density was significantly associated with poor OS (HR, 1.73; 95% CI, 1.10-2.73 per 10 microscopic fields) and poor RFS (HR, 1.62; 95% CI, 1.06-2.49) in T2 gallbladder cancer.
Higher subserosal vascular density may account for the higher incidence of cancer spread and the poor prognosis of T2b gallbladder cancer.
据报道，肿瘤位置（肝侧与腹膜侧）可预测T2期胆囊癌的微血管侵犯及生存结局，但其实际组织病理学机制尚未完全明确。
通过对84例胆囊癌患者胆囊壁血管密度进行组织病理学分析，重新探讨肿瘤位置的临床相关性。
肝侧肿瘤位置与T2期肿瘤的总生存期（OS）（风险比[HR]，13.62；95%置信区间[CI]，2.09 - 88.93）及无复发生存期（RFS）（HR，8.70；95% CI，1.36 - 55.69）相关。校正后的Kaplan-Meier曲线显示，T2a（腹膜侧）和T2b（肝侧）肿瘤之间存在明显的生存差异（P = 0.006）。对56例胆囊癌病理标本和20例对照标本的回顾显示，无论有无癌症，胆囊肝侧的浆膜下血管密度均显著更高（P < 0.001）。多因素分析还证实，在T2期胆囊癌中，较高的浆膜下血管密度与较差的OS（HR，1.73；95% CI，每10个显微镜视野1.10 - 2.73）及较差的RFS（HR，1.62；95% CI，1.06 - 2.49）显著相关。
较高的浆膜下血管密度可能是T2b期胆囊癌癌症扩散发生率较高及预后较差的原因。
