OBJECTIVES:The role of surgery in stage IV gallbladder (GB) cancer is not well established. This study analyses prognostic factors in patients with stage IV GB cancer following surgical resection with the aim of identifying a subgroup of patients who might benefit from surgical resection. METHODS:Clinicopathological details were analysed for 94 patients who were surgically treated for stage IV GB cancer at Seoul National University Hospital. RESULTS:Median survival was 8 months in patients with either stage IVa or IVb disease. Sixteen patients (17.0%) underwent resection with curative intent, which increased overall survival over that in patients undergoing palliative surgery (P < 0.001). No survival benefit was seen following surgery with curative intent in patients with stage IVa disease (P = 0.764). Surgery with curative intent resulted in a survival benefit in patients with stage IVb disease, patients with an isolated liver metastasis near the GB bed (median survival: 31 months vs. 9 months; P < 0.001) and patients with limited numbers of peritoneal implantations (median survival: 20 months vs. 6 months; P = 0.002). Preoperative serum carcinoembryonic antigen (CEA) (P = 0.018), surgery with curative intent (P = 0.045) and adjuvant chemotherapy (P = 0.002) were independent prognostic factors in patients with stage IV GB cancer. CONCLUSIONS:Surgery in combination with systemic chemotherapy may be beneficial in carefully selected patients with stage IVb GB cancer.

译文

目的:手术在IV期胆囊癌中的作用尚不明确。这项研究分析了手术切除后Ⅳ期GB期癌症患者的预后因素,目的是确定可能从手术切除中受益的患者亚组。
方法:分析了首尔国立大学医院94例行IV型GB癌症手术治疗的患者的临床病理资料。
结果:IVa或IVb期患者的中位生存期为8个月。 16例(17.0%)接受根治性切除术的患者,与接受姑息手术的患者相比,总体生存率有所提高(P <0.001)。 IVa期疾病患者经根治性手术后未见生存获益(P = 0.764)。具有治愈意图的手术可为IVb期疾病患者,GB床附近发生单纯肝转移的患者(中位生存期:31个月对9个月; P <0.001)和腹膜植入次数有限的患者带来生存益处(中位生存期:20个月与6个月; P = 0.002)。 Ⅳ期GB期癌症患者的术前血清癌胚抗原(CEA)(P = 0.018),有根治性手术(P = 0.045)和辅助化疗(P = 0.002)是独立的预后因素。
结论:外科手术结合全身化学疗法可能对精心挑选的IVb GB期癌症患者有益。

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