Who benefits from R0 resection? A single‐center analysis of patients with stage Ⅳ gallbladder cancer

Chronic Diseases and Translational Medicine - Tập 5 - Trang 188-196 - 2019
Chen Chen1, Lin Wang2, Rui Zhang1, Qi Li1, Ya-Ling Zhao3, Guan-Jun Zhang4, Wen-Zhi Li1, Zhi-Min Geng1
1Department of Hepatobiliary Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China
2Department of Geriatric Surgery, First Affiliated Hospital of Xi'an Jiaotong University, Xi’an, Shaanxi 710061, China
3Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University, Health Science Center, Xi’an, Shaanxi 710061, China
4Department of Pathology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, China

Tóm tắt

AbstractObjectivesMost patients with gallbladder cancer (GBC) present with advanced‐stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve survival in patients with GBC. This study aimed to analyze the prognostic factors in patients with stage Ⅳ GBC and to identify a subgroup of patients who might benefit from R0 resection.MethodsA total of 285 patients with stage Ⅳ GBC were retrospectively analyzed at our institution from January 2008 to December 2012. Factors potentially influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analyses.ResultsThe 1‐, 3‐, and 5‐year overall survival rates were 6.6% (15/229), 0.9% (2/229), and 0 (0/229), respectively. Ascites (relative risk [RR] = 1.631, 95% confidence interval [CI]: 1.221–2.180, P = 0.001), pathological grade (RR = 1.337, 95% CI: 1.050–1.702, P = 0.018), T stage (RR = 1.421, 95% CI: 1.099–1.837, P = 0.000), M stage (RR = 1.896, 95% CI: 1.409–2.552, P = 0.000), and surgery (RR = 1.542, 95% CI: 1.022–2.327, P = 0.039) were identified as independent risk factors influencing prognosis. The median survival time (MST) was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection (6.0 vs. 2.7 months; P < 0.001). In subgroup analyses, stage ⅣA patients benefited from R0 resection (MST for R0 vs. R1/R2, 11.0 vs. 4.0 months; P = 0.003), while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage ⅣB GBC without distant metastasis (MST for R0 vs. R1/R2, 6.0 vs. 3.0 months; P = 0.007).ConclusionAscites, pathological grade, T stage, M stage, and surgery were independent risk factors influencing prognosis in patients with stage IV GBC. N2 lymph node metastasis did not preclude curative resection, and radical resection should be considered in patients with stage Ⅳ GBC without distant metastasis once R0 margin was achieved.

Tài liệu tham khảo

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Chronic Diseases and Translational Medicine

Tập 5

188-196

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