Prognostic significance of regional lymphadenectomy in T1b gallbladder cancer:Results from 24 hospitals in China  

作　　者：Tai Ren Yong-Sheng Li Xue-Yi Dang Yang Li Zi-Yu Shao Run-Fa Bao Yi-Jun Shu Xu-An Wang Wen-Guang Wu Xiang-Song Wu Mao-Lan Li Hong Cao Kun-Hua Wang Hong-Yu Cai Chong Jin Hui-Han Jin Bo Yang Xiao-Qing Jiang Jian-Feng Gu Yun-Fu Cui Zai-Yang Zhang Chun-Fu Zhu Bei Sun Chao-Liu Dai Lin-Hui Zheng Jing-Yu Cao Zhe-Wei Fei Chang-Jun Liu Bing Li Jun Liu Ye-Ben Qian Yi Wang Ya-Wei Hua Xi Zhang Chang Liu Wan-Yee Lau Ying-Bin Liu 

机构地区：[1]Department of General Surgery,Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China [2]Shanghai Key Laboratory of Biliary Tract Disease Research,Shanghai 200092,China [3]Department of Biliary-Pancreatic Surgery,Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,Shanghai 200127,China [4]State Key Laboratory for Oncogenes and Related Genes,Shanghai 200127,China [5]Department of General Surgery,Shanxi Provincial Cancer Hospital,Taiyuan 030013,Shanxi Province,China [6]Department of GI Surgery,China-Japan Union Hospital of Jilin University,Changchun 130033,Jilin Province,China [7]Department of Gastrointestinal and Hernia Surgery,The First Affiliated Hospital of Kunming Medical University,Kunming 650031,Yunnan Province,China [8]Department of Hepatobiliary Surgery,Nantong Tumor Hospital,Nantong 226361,Jiangsu Province,China [9]Department of General Surgery,Taizhou Municipal Hospital,Taizhou 318000,Jiangsu Province,China [10]Department of Hepatobiliary Surgery,Wuxi Second People's Hospital,Wuxi 214002,Jiangsu Province,China [11]Department of General Surgery,The First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325015,Zhejiang Province,China [12]Department of Biliary Tract Surgery,Second Military Medical University,Secondary Military Medical University,Shanghai 200438,China [13]Department of General Surgery,Changshu No.1 People’s Hospital Affiliated to Soochow University,Changshu 215500,Jiangsu Province,China [14]Department of Hepatopancreatobiliary Surgery,Second Affiliated Hospital of Harbin Medical University,Harbin 150086,Heilongjiang Province,China [15]Department of General Surgery,Shaoxing Second Hospital,Shaoxing 312000,Zhejiang Province,China [16]Department of HPB Surgery,Changzhou No.2 People’s Hospital,Changzhou 213003,Jiangsu Province,China [17]Department of Pancreatic and Biliary Surgery,The First Affiliated Hospital of Harbin Medical University,Harbin 150009,Heilongjiang Province,China [18]Department of Hepatobiliar

出　　处：《World Journal of Gastrointestinal Surgery》2021年第2期176-186,共11页世界胃肠外科杂志（英文版）（电子版）

基　　金：National Natural Science Foundation of China(General Program),No.31620103910;National Natural Science Foundation of China(Key Program),No.81874181;National Health Commission of China,No.2019ZX09301158;Shanghai Municipal Commission of Economy and Informatization,No.2019RGZN01096;Shanghai Shenkang Hospital Development Center,No.12018107;and Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine,No.19XHCR13D.

摘　　要：BACKGROUND Whether regional lymphadenectomy(RL)should be routinely performed in patients with T1b gallbladder cancer(GBC)remains a subject of debate.AIM To investigate whether RL can improve the prognosis of patients with T1b GBC.METHODS We studied a multicenter cohort of patients with T1b GBC who underwent surgery between 2008 and 2016 at 24 hospitals in 13 provinces in China.The logrank test and Cox proportional hazards model were used to compare the overall survival(OS)of patients who underwent cholecystectomy(Ch)+RL and those who underwent Ch only.To investigate whether combined hepatectomy(Hep)improved OS in T1b patients,we studied patients who underwent Ch+RL to compare the OS of patients who underwent combined Hep and patients who did not.RESULTS Of the 121 patients(aged 61.9±10.1 years),77(63.6%)underwent Ch+RL,and 44(36.4%)underwent Ch only.Seven(9.1%)patients in the Ch+RL group had lymph node metastasis.The 5-year OS rate was significantly higher in the Ch+RL group than in the Ch group(76.3%vs 56.8%,P=0.036).Multivariate analysis showed that Ch+RL was significantly associated with improved OS(hazard ratio:0.51;95%confidence interval:0.26-0.99).Among the 77 patients who underwent Ch+RL,no survival improvement was found in patients who underwent combined Hep(5-year OS rate:79.5%for combined Hep and 76.1%for no Hep;P=0.50).CONCLUSION T1b GBC patients who underwent Ch+RL had a better prognosis than those who underwent Ch.Hep+Ch showed no improvement in prognosis in T1b GBC patients.Although recommended by both the National Comprehensive Cancer Network and Chinese Medical Association guidelines,RL was only performed in 63.6%of T1b GBC patients.Routine Ch+RL should be advised in T1b GBC.

关 键 词：Gallbladder cancer LYMPHADENECTOMY HEPATECTOMY STAGING PROGNOSIS SURGERY 

分 类 号：R735.8[医药卫生—肿瘤]