Examination of Prognostic Factors Affecting Long-Term Survival of Patients with Stage 3/4 Gallbladder Cancer without Distant Metastasis.

Ryota Higuchi,Takehiro Ota,Masakazu Yamamoto,Yutaro Matsunaga,Toru Furukawa,Tatsuo Araida,Takehisa Yazawa,Shuichirou Uemura

doi:10.3390/cancers12082073

Ryota Higuchi, Takehiro Ota + Show 6 more

Open Access

https://doi.org/10.3390/cancers12082073

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Journal: Cancers	Publication Date: Jul 27, 2020
Citations: 8	License type: CC BY 4.0

Affiliation: Tokyo Women's Medical University, Tohoku University

Abstract

In advanced gallbladder cancer (GBC) radical resection, if multiple prognostic factors are present, the outcome may be poor; however, the details remain unclear. To investigate the poor prognostic factors affecting long-term surgical outcome, we examined 157 cases of resected stage 3/4 GBC without distant metastasis between 1985 and 2017. Poor prognostic factors for overall survival and treatment outcomes of a number of predictable preoperative poor prognostic factors were evaluated. The surgical mortality was 4.5%. In multivariate analysis, blood loss, poor histology, liver invasion, and ≥4 regional lymph node metastases (LNMs) were independent prognostic factors for poor surgical outcomes; invasion of the left margin or the entire area of the hepatoduodenal ligament and a Clavien–Dindo classification ≥3 were marginal factors. The analysis identified outcomes of patients with factors that could be predicted preoperatively, such as liver invasion ≥5 mm, invasion of the left margin or the entire area of the hepatoduodenal ligament, and ≥4 regional LNMs. Thus, the five-year overall survival was 54% for zero factors, 34% for one factor, and 4% for two factors (p < 0.05). A poor surgical outcome was likely when two or more factors were predicted preoperatively; therefore, new treatment strategies are required for such patients.

Highlights

Gallbladder cancer (GBC) is a rare disease [1]; it has fewer chemotherapy regimens than other cancers, and surgery is the only curative treatment that can be expected to confer long-term survival in patients [2]
Without distant metastases, even if radical resection is obtained, the surgical outcome may be poor if multiple prognostic factors are observed
The R0 resection rate was found to be low in patients with high hepatoduodenal ligament (HDL) invasion, pancreatic invasion, invasion in two or more extrahepatic organs or structures, and major vascular invasion

Summary

Introduction

Gallbladder cancer (GBC) is a rare disease [1]; it has fewer chemotherapy regimens than other cancers, and surgery is the only curative treatment that can be expected to confer long-term survival in patients [2]. Cancers 2020, 12, 2073 hepatoduodenal infiltration, and lymph node metastasis [3,4], multiple modes of hepatectomy with lymph node dissection, bile duct resection, and sometimes a pancreaticoduodenectomy (PD) are required for radical resection. Determinants such as the tumor progression factor frequency that defines T3 or T4 staging, identification of strong prognostic factors, and surgical outcome in patients with multiple prognostic factors remain to be investigated. In patients with stage 3/4 GBC without distant metastases, even if radical resection is obtained, the surgical outcome may be poor if multiple prognostic factors are observed

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