Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, Zhejiang Province, China.
Zhejiang University School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
Cancer Med. 2023 Aug;12(16):16744-16755. doi: 10.1002/cam4.6297. Epub 2023 Jun 27.
The influencing factors, especially time to treatment (TTT), for T1b/T2 gallbladder cancer (GBC) patients remain unknown. We aimed to identify the influencing factors on survival and surgical approaches selection for T1b/T2 GBC.
We retrospectively screened GBC patients between January 2011 and August 2018 from our hospital. Clinical variables, including patient characteristics, TTT, overall survival (OS), disease-free survival (DFS), surgery-related outcomes, and surgical approaches were collected.
A total of 114 T1b/T2 GBC patients who underwent radical resection were included. Based on the median TTT of 7.5 days, the study cohort was divided into short TTT group (TTT ≤7 days, n = 57) and long TTT group (TTT >7 days, n = 57). Referrals were identified as the primary factor prolonging TTT (p < 0.001). There was no significance in OS (p = 0.790), DFS (p = 0.580), and surgery-related outcomes (all p > 0.05) between both groups. Decreased referrals (p = 0.005), fewer positive lymph nodes (LNs; p = 0.004), and well tumor differentiation (p = 0.004) were all associated with better OS, while fewer positive LNs (p = 0.049) were associated with better DFS. Subgroup analyses revealed no significant difference in survival between patients undergoing laparoscopic or open approach in different TTT groups (all p > 0.05). And secondary subgroup analyses found no significance in survival and surgery-related outcomes between different TTT groups of incidental GBC patients (all p > 0.05).
Positive LNs and tumor differentiation were prognostic factors for T1b/T2 GBC survival. Referrals associating with poor OS would delay TTT, while the prolonged TTT would not impact survival, surgery-related outcomes, and surgical approaches decisions in T1b/T2 GBC patients.
T1b/T2 期胆囊癌（GBC）患者的影响因素，尤其是治疗时间（TTT），仍不清楚。我们旨在确定 T1b/T2 GBC 患者生存和手术方式选择的影响因素。
我们回顾性筛选了 2011 年 1 月至 2018 年 8 月期间我院收治的 GBC 患者。收集了临床变量，包括患者特征、TTT、总生存期（OS）、无病生存期（DFS）、手术相关结局和手术方式。
共纳入 114 例接受根治性切除术的 T1b/T2 GBC 患者。根据 TTT 的中位数 7.5 天，将研究队列分为短 TTT 组（TTT≤7 天，n=57）和长 TTT 组（TTT＞7 天，n=57）。转诊被确定为延长 TTT 的主要因素（p＜0.001）。两组在 OS（p=0.790）、DFS（p=0.580）和手术相关结局（均 p＞0.05）方面均无差异。减少转诊（p=0.005）、阳性淋巴结（LNs）较少（p=0.004）和肿瘤分化良好（p=0.004）均与 OS 改善相关，而阳性 LNs 较少（p=0.049）与 DFS 改善相关。亚组分析显示，在不同 TTT 组中，腹腔镜或开放手术的患者在生存方面无显著差异（均 p＞0.05）。进一步的亚组分析发现，在意外 GBC 患者的不同 TTT 组中，生存和手术相关结局方面也无显著差异（均 p＞0.05）。
阳性 LNs 和肿瘤分化是 T1b/T2 GBC 生存的预后因素。与较差 OS 相关的转诊会延迟 TTT，而 T1b/T2 GBC 患者的 TTT 延长不会影响生存、手术相关结局和手术方式决策。
