Abstract
BackgroundRadical resection is an effective therapeutic method to increase the survival rate of patients with gallbladder cancer (GBC). In addition to the surgical approach, the relationships between various clinicopathologic factors and the outcome of patients with GBC remain controversial.MethodsClinical and laboratory examination characteristics, pathological and surgical data, and post-operative survival time of 338 patients with advanced GBC who received treatment at the First Affiliated Hospital of Xi'an Jiaotong University, China from January 2008 to December 2012 were analyzed retrospectively. Factors influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analysis.ResultsThe overall survival rates for curative resection patients were significantly greater than those for non-curative resection patients (1-,3-,5-year survival rate and mean-survival time: 59.0%, 47.3%, 44.3% and 22.0 months vs. 12.7%, 8.3%, 7.7% and 3.0 months) (P < 0.001). For the curative resection patients, positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites were all independent risk factors for poor prognosis. For patients with T3 stage, neither segmentectomy of IVb and V nor common bile duct resection improved the prognosis (P = 0.867 and P = 0.948). For patients with T4 stage, aggressive curative resection improved the prognosis (P = 0.007).ConclusionsAn advanced T stage does not preclude curative resection. Positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites are all independent risk factors for poor prognosis in the curative intent resection patients. The range of liver resection and whether common bile duct resection is performed do not influence the prognosis as long as R0 resection is achieved.
Highlights
Gallbladder cancer (GBC) is the most common malignant tumor of the biliary system, presenting features such as high degree of malignancy, difficult early diagnosis, poor therapeutic effects and prognosis, and with a dismal survival rate of 0–12% in most reports [1]
The overall survival rates for curative resection patients were significantly greater than those for non-curative resection patients (1,3,5-year survival rate and mean-survival time: 59.0%, 47.3%, 44.3% and 22.0 months vs. 12.7%, 8.3%, 7.7% and 3.0 months) (P < 0.001)
Enumeration data were expressed by percentage, and comparisons between groups were analyzed with the chi-square test
Summary
Gallbladder cancer (GBC) is the most common malignant tumor of the biliary system, presenting features such as high degree of malignancy, difficult early diagnosis, poor therapeutic effects and prognosis, and with a dismal survival rate of 0–12% in most reports [1]. The global rates for GBC exhibit striking variability, reaching epidemic levels for some regions and ethnicities. The basis for this high degree of variability likely resides in differences in environmental exposures and intrinsic genetic predisposition to carcinogenesis [2,3]. Radical resection has been shown to be an effective therapeutic method to increase the 5-year survival rate in patients with GBC [5]. Radical resection is an effective therapeutic method to increase the survival rate of patients with gallbladder cancer (GBC). In addition to the surgical approach, the relationships between various clinicopathologic factors and the outcome of patients with GBC remain controversial
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