Analysis of the Relationships between Clinicopathologic Factors and Survival in Gallbladder Cancer following Surgical Resection with Curative Intent

Xin-Wei Yang,Feng Shen,Meng-Chao Wu,Bao-Hua Zhang,Liang Li,Xiao-Bo Man,Jue Yang,Alejandro H Corvalan

doi:10.1371/journal.pone.0051513

Xin-Wei Yang, Feng Shen + Show 6 more

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https://doi.org/10.1371/journal.pone.0051513

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Abstract

BackgroundThis study elucidated the relationships between various clinicopathologic factors and the outcome of patients with gallbladder cancer (GBC) treated by surgical resection with curative intent.MethodsBetween January 2003 and January 2011, 76 patients with GBC underwent surgical resection with curative intent at our department. We then conducted a retrospective analysis of clinicopathologic data. Fourteen clinicopathological variables were selected for univariate and multivariate analysis to evaluate their influence on the outcome.ResultsThe actuarial 1-, 3-, and 5-year survival rates in the 76 resected cases were 56.6%, 32.7%, and 23.8%, respectively. The univariate analysis revealed that curative resection (P<0.001), lymph node metastasis (P<0.001), AJCC stage (P = 0.030), tumor location (P = 0.008), histologic differentiation (P = 0.028), intraoperative blood loss (P = 0.011), and preoperative jaundice (P = 0.012) were significant risk factors for survival. Multivariate analysis revealed that noncurative resection and tumor location on gallbladder neck were significant risk factors for poor outcome. Among jaundiced patients, we discovered that gallbladder carcinoma with tumor thrombus in common bile duct (CBD) was very rare but with relatively special clinical manifestation and characteristic radiography manifestation. The prognosis of gallbladder carcinoma with tumor thrombus in CBD after surgical procedure was apparently better than gallbladder carcinoma with invasion of hilar tissues.ConclusionsCurative surgical resection remains the only effective approach to the treatment of GBC. This series confirm that jaundice is a poor prognostic factor. However, the presence of jaundice does not preclude resection, especially in highly selected patients (when R0 resection is achievable). Gallbladder carcinoma with tumor thrombus in CBD has special clinical characteristics, which need to be awared by radiologists and clinicians.

Highlights

Gallbladder carcinoma has geographic and ethnic variation throughout the world and is a highly fatal malignant tumor
These characteristics of gallbladder cancer (GBC) result in advanced primary tumors and lymph node metastasis by the time of diagnosis
Because surgical resection is the only treatment that offers hope for cure, to elucidate the relationships between various clinicopathologic factors and the outcome of GBC patients treated by surgical resection with curative intent is very neccesary

Summary

Introduction

Gallbladder carcinoma has geographic and ethnic variation throughout the world and is a highly fatal malignant tumor. The poor prognosis of this disease is due to the anatomic position of the gallbladder and the nonspecific symptoms and signs [1,2] These characteristics of GBC result in advanced primary tumors and lymph node metastasis by the time of diagnosis. Jaundice in gallbladder cancer usually results from cancer infiltration of the extrahepatic bile duct and indicates advanced disease [6,7]. Many surgeons, especially those in Western countries, consider jaundice to be a contraindication to resection, despite the consensus that surgical resection offers the only chance of long-term survival [8,9]. This study elucidated the relationships between various clinicopathologic factors and the outcome of patients with gallbladder cancer (GBC) treated by surgical resection with curative intent

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Conclusion