Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Prognosis*; Gallbladder Neoplasms/*epidemiology ; Gallbladder Neoplasms/*surgery; Adult ; Aged ; Aged, 80 and over ; Common Bile Duct/pathology ; Common Bile Duct/surgery ; Disease-Free Survival ; Female ; Gallbladder Neoplasms/pathology ; Hepatectomy ; Humans ; Liver Neoplasms/epidemiology ; Liver Neoplasms/pathology ; Liver Neoplasms/secondary ; Liver Neoplasms/surgery ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Treatment Outcome

Background: 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.
Methods: Clinical 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.
Results: 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). 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).
Conclusions: An 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.
Competing Interests: The authors have declared that no competing interests exist.

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Date Created: 20161116 Date Completed: 20170621 Latest Revision: 20181113

20221213

PMC5112857

10.1371/journal.pone.0166361

27846279