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Dominguez DA, Wong P, Chen YJ, Singh GP, Fong Y, Li D, Ituarte PHG, Melstrom LG. Adjuvant Chemoradiation in Resected Biliary Adenocarcinoma: Evaluation of SWOG S0809 with a Large National Database. Ann Surg Oncol 2024; 31:4896-4904. [PMID: 38443700 PMCID: PMC11236922 DOI: 10.1245/s10434-024-15117-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND There is a paucity of evidence supporting the use of adjuvant radiation therapy in resected biliary cancer. Supporting evidence for use comes mainly from the small SWOG S0809 trial, which demonstrated an overall median survival of 35 months. We aimed to use a large national database to evaluate the use of adjuvant chemoradiation in resected extrahepatic bile duct and gallbladder cancer. METHODS Using the National Cancer Database, we selected patients from 2004 to 2017 with pT2-4, pN0-1, M0 extrahepatic bile duct or gallbladder adenocarcinoma with either R0 or R1 resection margins, and examined factors associated with overall survival (OS). We examined OS in a cohort of patients mimicking the SWOG S0809 protocol as a large validation cohort. Lastly, we compared patients who received chemotherapy only with patients who received adjuvant chemotherapy and radiation using entropy balancing propensity score matching. RESULTS Overall, 4997 patients with gallbladder or extrahepatic bile duct adenocarcinoma with available survival information meeting the SWOG S0809 criteria were selected, 469 of whom received both adjuvant chemotherapy and radiotherapy. Median OS in patients undergoing chemoradiation was 36.9 months, and was not different between primary sites (p = 0.841). In a propensity score matched cohort, receipt of adjuvant chemoradiation had a survival benefit compared with adjuvant chemotherapy only (hazard ratio 0.86, 95% confidence interval 0.77-0.95; p = 0.004). CONCLUSION Using a large national database, we support the findings of SWOG S0809 with a similar median OS in patients receiving chemoradiation. These data further support the consideration of adjuvant multimodal therapy in resected biliary cancers.
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Affiliation(s)
- Dana A Dominguez
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Paul Wong
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Yi-Jen Chen
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Gagandeep P Singh
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Yuman Fong
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Daneng Li
- Department of Medical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Philip H G Ituarte
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA
| | - Laleh G Melstrom
- Department of Surgical Oncology, City of Hope National Medical Center, Duarte, CA, USA.
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Gholami S, Colby S, Horowitz DP, Guthrie KA, Ben-Josef E, El-Khoueiry AB, Blanke CD, Philip PA, Kachnic LA, Ahmad SA, Rocha FG. Adjuvant Chemoradiation in Patients with Lymph Node-Positive Biliary Tract Cancers: Secondary Analysis of a Single-Arm Clinical Trial (SWOG 0809). Ann Surg Oncol 2023; 30:1354-1363. [PMID: 36622529 PMCID: PMC10695673 DOI: 10.1245/s10434-022-12863-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/10/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND SWOG 0809 is the only prospective study of adjuvant chemotherapy followed by chemoradiation focusing on margin status in patients with extrahepatic cholangiocarcinoma (EHCC) and gallbladder cancer (GBCA); however, the effects of adjuvant therapy by nodal status have never been reported in this population. METHODS Patients with resected EHCC and GBCA, stage pT2-4, node-positive (N+) or margin-positive (R1) who completed four cycles of chemotherapy followed by radiotherapy were included. Cox regression was used to compare overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis by nodal status. DFS rates were compared with historical data via a one-sample t-test. RESULTS Sixty-nine patients [EHCC, n = 46 (66%); GBCA, n = 23 (33%)] were evaluated, with a median age of 61.7 years and an R0 rate of 66.7% and R1 rate of 33.3%. EHCC versus GBCA was more likely to be N+ (73.9% vs. 47.8%, p = 0.03). Nodal status did not significantly impact OS (hazard ratio [HR] 1.98, 95% confidence interval [CI] 0.86-4.54, p = 0.11) or DFS (HR 1.63, 95% CI 0.77-3.44, p = 0.20). Two-year OS was 70.6% for node-negative (N0) disease and 60.9% for N+ disease, while 2-year DFS was 62.5% for N0 tumors and 49.8% for N+ tumors. N+ versus N0 tumors showed higher rates of distant failure (42.2% vs. 25.0%, p = 0.04). The 2-year DFS rate in N+ tumors was significantly higher than in historical controls (49.8% vs. 29.7%, p = 0.004). CONCLUSIONS Adjuvant therapy is associated with favorable outcome independent of nodal status and may impact local control in N+ patients. These data could serve as a benchmark for future adjuvant trials, including molecular-targeted agents.
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Affiliation(s)
- Sepideh Gholami
- Department of Surgery, University of California, Davis, CA, USA.
| | - Sarah Colby
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - David P Horowitz
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York City, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York City, NY, USA
| | - Katherine A Guthrie
- SWOG Statistics and Data Management Center, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Edgar Ben-Josef
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Anthony B El-Khoueiry
- Department of Clinical Medicine, University of Southern California, Los Angeles, CA, USA
| | - Charles D Blanke
- SWOG Group Chair's Office, Oregon Health Sciences University, Knight Cancer Institute, Portland, OR, USA
| | - Philip A Philip
- Department of Oncology and Department of Pharmacology, School of Medicine, Wayne State University, Karmanos Cancer Center, Detroit, MI, USA
| | - Lisa A Kachnic
- Department of Radiation Oncology, Columbia University Irving Medical Center, New York City, NY, USA
- Herbert Irving Comprehensive Cancer Center, New York City, NY, USA
| | - Syed A Ahmad
- Department of Surgery, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Flavio G Rocha
- Division of Surgical Oncology, Oregon Health Sciences University, Knight Cancer Institute, Portland, OR, USA
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Contrast-enhanced CT radiomics for prediction of recurrence-free survival in gallbladder carcinoma after surgical resection. Eur Radiol 2022; 32:7087-7097. [PMID: 35612664 DOI: 10.1007/s00330-022-08858-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 04/11/2022] [Accepted: 04/30/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Gallbladder carcinoma (GBC) is the most common and aggressive biliary tract malignancy with high postoperative recurrence rates. This single-center study aimed to develop and validate a radiomics signature to estimate GBC recurrence-free survival (RFS). METHODS This study retrospectively included 204 consecutive patients with pathologically diagnosed GBC and were randomly divided into development (n = 142) and validation (n = 62) cohorts (7:3). The radiomics features of tumor were extracted from preoperative contrast-enhanced CT imaging for each patient. In the development cohort, the least absolute shrinkage and selection operator (LASSO) Cox regression was employed to develop a radiomics signature for RFS prediction. The patients were stratified into high-score or low-score groups according to their median value of radiomics score. A nomogram was established using multivariable Cox regression by incorporating significant pathological predictors and radiomics signatures. RESULTS The radiomics signature based on 12 features could discriminate high-risk patients with poor RFS. Multivariate Cox analysis revealed that pT3/4 stage (hazard ratio, [HR] = 2.691), pN2 stage (HR = 3.60), poor differentiation grade (HR = 2.651), and high radiomics score (HR = 1.482) were independent risk variables associated with worse RFS and were incorporated to construct a nomogram. The nomogram displayed good prediction performance in estimating RFS with AUC values of 0.895, 0.935, and 0.907 at 1, 3, and 5 years, respectively. CONCLUSIONS The radiomics signature and combined nomogram may assist in predicting RFS in GBC patients. KEY POINTS • A radiomics signature extracted from preoperative contrast-enhanced CT can be a useful tool to preoperatively predict RFS of GBC. • T3/T4 stage, N2, poor tumor differentiation, and high radiomics score were positively associated with postoperative recurrence.
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Li L, Ren T, Liu K, Li ML, Geng YJ, Yang Y, Li HF, Li XC, Bao RF, Shu YJ, Weng H, Gong W, Lau WY, Wu XS, Liu YB. Development and Validation of a Prognostic Nomogram Based on the Systemic Immune-Inflammation Index for Resectable Gallbladder Cancer to Predict Survival and Chemotherapy Benefit. Front Oncol 2021; 11:692647. [PMID: 34268122 PMCID: PMC8276054 DOI: 10.3389/fonc.2021.692647] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/07/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives To investigate the prognostic significance of the systemic immune-inflammation index (SII) in patients after radical cholecystectomy for gallbladder cancer (GBC) using overall survival (OS) as the primary outcome measure. Methods Based on data from a multi-institutional registry of patients with GBC, significant prognostic factors after radical cholecystectomy were identified by multivariate Cox proportional hazards model. A novel staging system was established, visualized as a nomogram. The response to adjuvant chemotherapy was compared between patients in different subgroups according to the novel staging system. Results Of the 1072 GBC patients enrolled, 691 was randomly selected in the discovery cohort and 381 in the validation cohort. SII>510 was found to be an independent predictor of OS (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.42-2.54). Carbohydrate antigen 199(CA19-9), tumor differentiation, T stage, N stage, margin status and SII were involved in the nomogram. The nomogram showed a superior prediction compared with models without SII (1-, 3-, 5-year integrated discrimination improvement (IDI):2.4%, 4.1%, 5.4%, P<0.001), and compared to TNM staging system (1-, 3-, 5-year integrated discrimination improvement (IDI):5.9%, 10.4%, 12.2%, P<0.001). The C-index of the nomogram in predicting OS was 0.735 (95% CI 0.683-0.766). The novel staging system based on the nomogram showed good discriminative ability for patients with T2 or T3 staging and with negative lymph nodes after R0 resection. Adjuvant chemotherapy offered significant survival benefits to these patients with poor prognosis. Conclusions SII was an independent predictor of OS in patients after radical cholecystectomy for GBC. The new staging system identified subgroups of patients with T2 or T3 GBC with negative lymph nodes who benefited from adjuvant chemotherapy. Clinical Trial Registration ClinicalTrials.gov, identifier (NCT04140552).
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Affiliation(s)
- Lin Li
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tai Ren
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China
| | - Ke Liu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mao-Lan Li
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya-Jun Geng
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Yang
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huai-Feng Li
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue-Chuan Li
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Run-Fa Bao
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Jun Shu
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Weng
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Gong
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, Hong Kong
| | - Xiang-Song Wu
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Bin Liu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Cancer Institute, State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
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Akhtar-Danesh N, Akhtar-Danseh GG, Seow H, Shakeel S, Finley C. Treatment Modality and Trends in Survival for Gallbladder Cancer: a Population-Based Study. J Gastrointest Cancer 2021; 52:256-262. [PMID: 32185744 DOI: 10.1007/s12029-020-00397-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE There are only a few reports on the treatment-based survival of gallbladder cancer (GBC). The primary objective of this study was to examine the change in treatment modality and the related trends in the survival of GBC. METHODS This study includes all cases of primary GBC diagnosed in the province of Ontario, Canada, from January 2007 to December 2015 with known disease stage. Treatment modalities were classified as no treatment, radiation or chemotherapy, and surgical resection. We examined the association between surgical resection and demographics and tumor characteristics and estimated the trends in survival based on treatment modality. RESULTS In total, 564 patients with GBC were identified, of which 374 (66.3%) were female. Although there were no significant trends in treatment modalities over the study period (p = 0.276), survival rates improved for all treatment modalities over time. There was a 35% increase in 5-year survival for the surgical resection group from 2007 to 2015. For patients with stage I-II disease, the 5-year survival rate increased 40% over time. The highest 5-year survival was observed for the surgical resection group in patients with stage I-II disease (0.533 (95% CI, 0.514-0.552)) while the average 5-year survival rate for all patients over the study period was 0.247 (95% CI, 0.228-0.266). CONCLUSIONS Most cases of GBC continue to be diagnosed in the late stage. Five-year survival for the surgical resection group has markedly improved over time, specifically for patients with stage I-II disease which increased from 30% in 2007 to 70% in 2015.
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Affiliation(s)
- Noori Akhtar-Danesh
- School of Nursing, McMaster University, 1280 Main St. West, Room 3N28B, Hamilton, ON, l8S 4K1, Canada. .,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.
| | | | - Hsien Seow
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada.,Department of Oncology, McMaster University, Hamilton, Canada
| | - Saad Shakeel
- School of Medicine, University of Toronto, Toronto, Canada
| | - Christian Finley
- Division of Thoracic Surgery, Department of Surgery, McMaster University, Hamilton, Canada
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Prognostic Value of Carcinoembryonic Antigen (CEA) and Carbohydrate Antigen 19-9 (CA 19-9) in Gallbladder Cancer; 65 IU/mL of CA 19-9 Is the New Cut-Off Value for Prognosis. Cancers (Basel) 2021; 13:cancers13051089. [PMID: 33806265 PMCID: PMC7961941 DOI: 10.3390/cancers13051089] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/25/2021] [Accepted: 02/28/2021] [Indexed: 12/28/2022] Open
Abstract
Simple Summary Gallbladder cancer (GBC) is the fifth most common cancer of the digestive tract, and preoperative tumor markers for GBC have been studied as a less invasive way to detect the presence of the cancer. CEA and CA 19-9 have been most commonly used for detecting GBC clinically, and various cut-off values were suggested to satisfy this purpose, but there has still been a lack of proper values of these tumor markers to predict the prognosis of GBC. We have aimed to suggest appropriate cut-off values that could help to anticipate prognosis in the preoperative period. Data from carefully selected 539 patients were used in our study, the new cut-off value, 65 IU/mL for CA 19-9 was derived through an up-to-date statistical method. By using this cut-off value, clinicians could get the important reference in the establishment of the strategy of treatment, and the researches about this topic could become more vigorous. Abstract Due to the lack of appropriate tumor markers with optimal cut-off values to predict the prognosis of gallbladder cancer (GBC), this study aimed to demonstrate the relationship between prognosis and the levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9), and to determine optimal thresholds. In total, 539 patients diagnosed with GBC were examined. The relationship between tumor marker levels and overall survival (OS) was analyzed. The C-tree method was used to suggest tumor marker thresholds, and multivariate analysis was conducted to identify prognostic factors for overall survival. The mean age of the patients was 65.3 years, and the 5-year overall survival rate in all patients was 68.9%. Following the C-tree method, the optimal cut-off value was set at 5 IU/mL for CEA and at 65 IU/mL for CA 19-9. Multivariate analysis revealed that age, CA 19-9 level, operative method, T stage, and N stage were significant prognostic factors for OS. Consequently, CA 19-9 had a stronger association with prognosis than CEA, and 65 IU/mL for CA 19-9 may be suggestive in evaluating the prognosis of GBC. Moreover, it could be an effective indicator for determining the surgical extent necessary and the need for adjuvant treatment.
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Chen M, Li S, Topatana W, Lv X, Cao J, Hu J, Lin J, Juengpanich S, Shen J, Cai X. Development and Validation of a Nomogram for Predicting Survival in Gallbladder Cancer Patients With Recurrence After Surgery. Front Oncol 2021; 10:537789. [PMID: 33505902 PMCID: PMC7829964 DOI: 10.3389/fonc.2020.537789] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The management of gallbladder cancer (GBC) patients with recurrence who need additional therapy or intensive follow-up remains controversial. Therefore, we aim to develop a nomogram to predict survival in GBC patients with recurrence after surgery. METHODS A total of 313 GBC patients with recurrence from our center was identified as a primary cohort, which were randomly divided into a training cohort (N = 209) and an internal validation cohort (N = 104). In addition, 105 patients from other centers were selected as an external validation cohort. Independent prognostic factors, identified by univariate and multivariable analysis, were used to construct a nomogram. The performance of this nomogram was measured using Harrell's concordance index (C-index) and calibration curves. RESULTS Our nomogram was established by four factors, including time-to-recurrence, site of recurrence, CA19-9 at recurrence, and treatment of recurrence. The C-index of this nomogram in the training, internal and external validation cohort was 0.871, 0.812, and 0.754, respectively. The calibration curves showed an optimal agreement between nomogram prediction and actual observation. Notably, this nomogram could accurately stratify patients into different risk subgroups, which allowed more significant distinction of Kaplan-Meier curves than that of using T category. The 3-year post-recurrence survival (PRS) rates in the low-, medium-, and high-risk subgroups from the external validation cohort were 53.3, 26.2, and 4.1%, respectively. CONCLUSION This nomogram provides a tool to predict 1- and 3-year PRS rates in GBC patients with recurrence after surgery.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, China
| | - Shijie Li
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Win Topatana
- Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaozhong Lv
- Department of General Surgery, First People’s Hospital, Mudanjiang, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiahao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Lin
- Department of General Surgery, Longyou People’s Hospital, Quzhou, China
| | | | - Jiliang Shen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University School of Medicine, Hangzhou, China
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Liang H, Wang Y, Chen J, Xing J, Pu Y. The Efficacy of Adjuvant Chemoradiotherapy in Early-Stage Gallbladder Adenocarcinoma Depends on the Tumor Invasion Depth and Differentiation Level. Front Oncol 2020; 10:616170. [PMID: 33392099 PMCID: PMC7775593 DOI: 10.3389/fonc.2020.616170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/16/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Although the performance of adjuvant chemoradiotherapy (ACRT) for resected gallbladder cancer may improve the survival for certain patients, its impact on the survival in early-stage resected gallbladder adenocarcinoma (GBAC) patients remains underexplored. This study aimed to determine the ACRT effects on the survival of early-stage resected GBAC patients. METHODS Patients with early-stage resected GBAC diagnosed between 2010 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. The covariables included gender, age, race, tumor differentiation, TNM stage (AJCC TNM staging system, 7th edition), adjuvant radiotherapy (ART), and adjuvant chemotherapy (ACT). The effects of ACRT on survival were evaluated by univariate and multivariate analysis. RESULTS A total of 1,586 patients with resected GBAC met the inclusion criteria were included in this study. Patients who received ACT were older, with poorer tumor differentiation or higher TNM stage (all p < 0.05), while patients who underwent ART were proved to be significantly correlated with poorer tumor differentiation (p = 0.010) and higher TNM stage (p < 0.001). Univariate and multivariate analysis of overall survival (OS) showed that age (p < 0.001; HR, 2.039; 95% CI, 1.718-2.420), tumor grade (p < 0.001; HR, 1.887; 95% CI, 1.530-2.370), and AJCC 7th TNM stage (p < 0.001; HR, 1.417; 95% CI, 1.182-1.699) were independent prognostic risk factors. Interestingly, ART and ACT were not independently associated with improved OS in the overall cohort analysis. However, when patients were subgrouped according to tumor differentiation, ART (p = 0.049; HR, 0.639; 95% CI, 0.409-0.999) has been identified as a significant prognostic factor for grade III/IV patients. Meanwhile, ARC (p = 0.011; HR, 0.739; 95% CI, 0.586-0.932) was associated with improved OS among tumor stage II patients (p<0.001). CONCLUSION ACRT may have specific survival benefits for early-stage resected GBAC patients. ART can improve survival in patients with poor or absent tumor differentiation. Besides, patients with tumor invasion beyond muscularis (stage II tumor) may benefit from ACT. Our study provides supporting evidence for the clinical applications of ACRT in early-stage GBAC patients.
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Affiliation(s)
- Hui Liang
- Department of General Surgery, Naval Medical Center of PLA, Shanghai, China
| | - Yifan Wang
- Department of General Surgery, Naval Medical Center of PLA, Shanghai, China
| | - Jie Chen
- Department of Cardiothoracic Surgery, Naval Medical Center of PLA, Shanghai, China
| | - Jiajun Xing
- Department of Orthopedics, Naval Medical Center of PLA, Shanghai, China
| | - Yabin Pu
- Department of General Surgery, Naval Medical Center of PLA, Shanghai, China
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9
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Im JH, Lee WJ, Kang CM, Hwang HK, Seong J. Prognostic factors and patterns of loco-regional failure in patients with R0 resected gallbladder cancer. HPB (Oxford) 2020; 22:1168-1173. [PMID: 31784211 DOI: 10.1016/j.hpb.2019.10.2447] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/29/2019] [Accepted: 10/30/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND In this study, risk factors for loco-regional recurrence in curative R0 resected gallbladder adenocarcinoma were investigated. METHODS Patients with gallbladder adenocarcinoma with curative R0 resections between 2000 and 2016 were retrospectively reviewed. Loco-regional failure-free survival (LRFFS) and overall survival (OS) were analyzed using the Kaplan-Meier method; prognostic factors were analyzed using the Cox proportional hazards model. Based on the identified risk factors, patients were grouped for further analysis. RESULTS A total of 272 patients were included for analysis; overall, 5-year LRFFS and OS were 83% and 81%, respectively. On multivariate analysis, 3 risk factors for LRFFS were identified; lymphovascular invasion, T3, and N1, by which patients were grouped; group 1 for 0 factor, group 2 for 1 factor and group 3 for 2 to 3 factors. The 5-year LRFFS in groups 1, 2, and 3 were 94%, 73%, and 40%, and the 5-year OS in groups 1, 2, and 3 were 90%, 75%, and 47%, respectively. LRFFS and OS differed significantly among groups (p < 0.05). CONCLUSION In patients with R0 resected gallbladder cancer, the presence of >1 risk factor increased the risk of loco-regional recurrence. Additional therapeutic strategy for these patients needs further consideration.
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Affiliation(s)
- Jung Ho Im
- Departments of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Woo Jung Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chang Moo Kang
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Ho Kyoung Hwang
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jinsil Seong
- Departments of Radiation Oncology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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10
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Lamarca A, Edeline J, McNamara MG, Hubner RA, Nagino M, Bridgewater J, Primrose J, Valle JW. Current standards and future perspectives in adjuvant treatment for biliary tract cancers. Cancer Treat Rev 2020; 84:101936. [PMID: 31986437 DOI: 10.1016/j.ctrv.2019.101936] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 02/06/2023]
Abstract
Biliary tract cancer, including cholangiocarcinoma (CCA) and gallbladder cancer (GBC) are rare tumours with a rising incidence. Prognosis is poor, since most patients are diagnosed with advanced disease. Only ~20% of patients are diagnosed with early-stage disease, suitable for curative surgery. Despite surgery performed with potentially-curative intent, relapse rates are high, with around 60-70% of patients expected to have disease recurrence. Most relapses occur in the form of distant metastases, with a predominance of liver spread. In view of high tumour recurrence, adjuvant strategies have been explored for many years, in the form of radiotherapy, chemo-radiotherapy and chemotherapy. Historically, few randomised trials were available, which included a variety of additional tumours (e.g. pancreatic and ampullary tumours); most evidence relied on phase II and retrospective studies, with no high-quality evidence available to define the real benefit derived from adjuvant strategies. Since 2017, three randomised phase III clinical trials have been reported; all recruited patients with resected biliary tract cancer (CCA and GBC) who were randomised to observation alone, or chemotherapy in the form of gemcitabine (BCAT study; included patients diagnosed with extrahepatic CCA only), gemcitabine and oxaliplatin (PRODIGE-12/ACCORD-18; included patients diagnosed with CCA and GBC) or capecitabine (BILCAP; included patients diagnosed with CCA and GBC). While gemcitabine-based chemotherapy failed to show an impact on patient outcome (relapse-free survival (RFS) or overall survival (OS)), the BILCAP study showed a benefit from adjuvant capecitabine in terms of OS (pre-planned sensitivity analysis in the intention-to-treat population and in the per-protocol analysis), with confirmed benefit in terms of RFS. Based on the BILCAP trial, international guidelines recommend adjuvant capecitabine for a period of six months following potentially curative resection of CCA as the current standard of care for resected CCA and GBC. However, BILCAP failed to show OS benefit in the intention-to-treat (non-sensitivity analysis) population (primary end-point), and this finding, as well as some inconsistencies between studies has been criticised and has led to confusion in the biliary tract cancer medical community. This review summarises the adjuvant field in biliary tract cancer, with evidence before and after 2017, and comparison between the latest randomised phase III studies. Potential explanations are presented for differential findings, and future steps are explored.
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Affiliation(s)
- Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - Julien Edeline
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Mairéad G McNamara
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Richard A Hubner
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Masato Nagino
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - John Bridgewater
- Department of Medical Oncology, UCL Cancer Institute, London, United Kingdom
| | - John Primrose
- Department of Surgery, University of Southampton, Southampton, United Kingdom
| | - Juan W Valle
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK; Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
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11
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Sirivatanauksorn V, Dumronggittigule W, Dulnee B, Srisawat C, Sirivatanauksorn Y, Pongpaibul A, Masaratana P, Somboonyosdech C, Sripinitchai S, Kositamongkol P, Mahawithitwong P, Tovikkai C, Sangserestid P, Limsrichamrern S. Role of stratifin (14-3-3 sigma) in adenocarcinoma of gallbladder: A novel prognostic biomarker. Surg Oncol 2019; 32:57-62. [PMID: 31751820 DOI: 10.1016/j.suronc.2019.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/23/2019] [Accepted: 10/28/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Gallbladder cancer (GBC) is a rare and fatal biliary tract malignancy. Genetic derangements are one of many factors that determine the prognosis of GBC. In this study, the expression of the stratifin (SFN) gene encoding 14-3-3 sigma protein, which is reported to be associated with the metastatic property of cholangiocarcinoma cells, was investigated in GBC. MATERIAL AND METHODS Formalin-fixed paraffin-embedded cancer (n = 37) and non-cancer control tissues (n = 14) of gallbladders from patients who underwent surgical resection from January 2006 to May 2015 were retrieved. The expression of SFN normalized with that of ACTB was determined using RT-qPCR. Multivariate analysis of factors affecting disease-free survival (DFS) and overall survival (OS) including the type of SFN expression was performed. RESULT The average expression level of SFN in cancer was higher than that in control tissues (p = 0.002). The relative SFN expression in cancer tissue was classified as overexpression (n = 14) and control level expression (n = 23) according to the receiver operating characteristic (ROC) curves for discriminating early GBC recurrence or metastasis after surgery. The SFN overexpression group was associated with lower rates of distant metastasis and early tumor recurrence following resection. The univariate analysis demonstrated factors affecting DFS, including resection margin (p < 0.001), lymphovascular invasion (p = 0.040), perineural invasion (p = 0.046), and SFN expression (p < 0.001). The multivariate analysis revealed that the resection margin (p = 0.019) and SFN expression (P = 0.040) were independent prognostic factors of DFS. CONCLUSION To achieve the longest survival, margin-free resection is recommended. The overexpression of SFN in GBC is associated with better prognosis, lower rates of early cancer recurrence, and distant metastasis following resection. SFN expression might be a novel prognostic biomarker in GBC treatment. Further studies to elucidate the role of SFN might unveil its clinical benefit in cancer treatment regimens.
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Affiliation(s)
- Vorapan Sirivatanauksorn
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Wethit Dumronggittigule
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Benjamaporn Dulnee
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chatchawan Srisawat
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Yongyut Sirivatanauksorn
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Ananya Pongpaibul
- Department of Pathology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Patarabutr Masaratana
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chayapol Somboonyosdech
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirinapa Sripinitchai
- Department of Biochemistry and NANOTEC, Mahidol University Center of Excellence in Nanotechnology for Cancer Diagnosis and Treatment, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prawat Kositamongkol
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Prawej Mahawithitwong
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Chutwichai Tovikkai
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Pholasith Sangserestid
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Somchai Limsrichamrern
- Hepatopancreatobiliary and Transplant Surgery Unit, Division of General Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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12
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Manterola C, Duque G, Grande L, de Aretxabala X, Conejeros R, Otzen T, García N. A systematic review of the effectiveness of adjuvant therapy for patients with gallbladder cancer. HPB (Oxford) 2019; 21:1427-1435. [PMID: 30922845 DOI: 10.1016/j.hpb.2019.02.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/15/2019] [Accepted: 02/26/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Equipoise exists regarding the benefit of adjuvant therapy (AT) in patients with gallbladder cancer (GBC). The aim of this study was to critically review the available evidence for the effectiveness of AT in patients with GBC following surgery with curative intent. METHODS A systematic review was performed. Relevant studies were identified from Trip Database, BIREME-BVS, SciELO, Cochrane Central Register, WoS, MEDLINE, EMBASE and SCOPUS. Adjuvant therapies considered included chemotherapy, chemoradiotherapy, and radiotherapy. The primary outcome was overall survival (OS). Subgorup analysis of patients with positive lymph node disease (PLND), positive surgical margin (PSM), or advanced stage (AS) were performed. RESULTS 748 related articles were identified; 27 met the selection criteria (3 systematic reviews and 24 observational studies). Evidence provided was moderate, poor and very poor for chemotherapy, chemoradiotherapy, and radiotherapy. Existing evidence is not robust, but suggests certain benefits with AT in improving OS, especially in patients with PLND, PSM and AS. CONCLUSION Results do not provide strong evidence that AT is effective in patients who undergo resection for GBC. Subgroups of PLND and PSM may have a survival advantage. Future studies with appropriate internal validity and adequate number of patients are required to better answer this question.
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Affiliation(s)
- Carlos Manterola
- Department of Surgery, Universidad de La Frontera, Chile; Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Chile; PhD Program in Medical Sciences, Universidad de La Frontera, Chile.
| | - Galo Duque
- PhD Program in Medical Sciences, Universidad de La Frontera, Chile; Faculty of Medicine, Universidad del Azuay, Cuenca, Ecuador
| | - Luis Grande
- Department of Surgery, Hospital Clínico del Mar, Barcelona, Spain
| | | | | | - Tamara Otzen
- Center of Excellence in Morphological and Surgical Studies (CEMyQ), Universidad de La Frontera, Chile; PhD Program in Medical Sciences, Universidad de La Frontera, Chile
| | - Nayely García
- PhD Program in Medical Sciences, Universidad de La Frontera, Chile
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13
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Benefit of Adjuvant Chemoradiotherapy in Resected Gallbladder Carcinoma. Sci Rep 2019; 9:11770. [PMID: 31409811 PMCID: PMC6692378 DOI: 10.1038/s41598-019-48099-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 07/30/2019] [Indexed: 12/13/2022] Open
Abstract
To evaluate the benefit of adjuvant treatments, such as chemoradiotherapy (CRT) and chemotherapy (CTx), compared with no adjuvant treatment (No-AT) in resected gallbladder (GB) cancer patients, 151 patients were analyzed: 98 (64.9%) patients received adjuvant treatment with CRT (n = 59, 39.1%) or CTx (n = 39, 25.8%), and the remaining 53 (35.1%) did not (No-AT). The clinicopathological factors, patterns of failure, locoregional recurrence-free survival (LRFS), recurrence-free survival (RFS) and overall survival (OS) were compared among the three groups according to tumor stage. In patients with T2-3N0M0 stage disease, the incidences of locoregional recurrence and distant recurrence and 5-year LRFS, RFS and OS rates were not significantly different among the No-AT, CTx, and CRT groups (p > 0.05 each). In those with T2-3N1-2M0 stage disease, the incidences of locoregional recurrence (11.4%, 78.1%, and 68.4%, respectively) and distant recurrence (42.8%, 73.9% and 66.7%, respectively) in the CRT group were significantly lower than those in the No-AT and CTx groups (p < 0.05), and the CRT group had significantly higher 5-year LRFS (82,1%, 26.8%, and 19.0%), RFS (53.3%, 11.6% and 16.7%) and OS rates (64.0%, 22.7% and 4.3%) than the CTx and No-AT groups (p < 0.05 each). Therefore, adjuvant CRT may improve the LRFS and RFS and subsequently improve OS in lymph node-positive resected GB cancer.
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14
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Abstract
RATIONALE Gallbladder cancer (GBC) is a highly fatal malignancy. Due to its invasiveness and delayed diagnosis, many GBC patients are diagnosed with synchronous liver and hepatoduodenal ligament involvement. In our case, we report a gallbladder cancer with portal vein thrombus. PATIENT CONCERNS A 60-year-old woman presented with persistent upper abdominal dull pain for 2 months. DIAGNOSES Ultrasound examination showed gallbladder carcinoma invading liver segment IV, and a tumor thrombus in the left and right main portal trunk. Ultrasonography and contrast-enhanced magnetic resonance imaging (MRI) showed gallbladder carcinoma with invasion of adjacent liver, and tumor thrombus in the right branch of the portal vein and intrahepatic bile duct. Abdominal computed tomography angiography (CTA) revealed no hepatic artery invasion. INTERVENTIONS We made a decision to perform extended right lobectomy. Twenty-six days later, the patient underwent intravenous infusion port implantation for S-1 plus oxaliplatin (SOX) therapy. OUTCOMES After treatment, the patient has been doing very well and no recurrence has been found for 5 months. LESSONS The patient with gallbladder cancer and tumor thrombus in the portal vein described in this report provides a reminder for surgeons of the importance of early diagnosis, and adequate surgical and adjuvant treatment. Multi-disciplinary treatment is significantly beneficial for the overall survival of patients with advanced GBC.
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Affiliation(s)
- Xiao-Zhen Zhang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Jian-Jun Tu
- Department of Surgery, Kaihua People's Hospital, Quzhou, China
| | - Wei Chen
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Tao Ma
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Xue-Li Bai
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
| | - Ting-Bo Liang
- Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou
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15
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Gu B, Qian L, Yu H, Hu J, Wang Q, Shan J, Shi L, Liu H, Yang Q, Liang X, Cai X, Sun X. Concurrent Chemoradiotherapy in Curatively Resected Gallbladder Carcinoma: A Propensity Score–Matched Analysis. Int J Radiat Oncol Biol Phys 2018; 100:138-145. [DOI: 10.1016/j.ijrobp.2017.09.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/24/2017] [Accepted: 09/13/2017] [Indexed: 12/13/2022]
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16
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Kim BH, Kwon J, Chie EK, Kim K, Kim YH, Seo DW, Narang AK, Herman JM. Adjuvant Chemoradiotherapy is Associated with Improved Survival for Patients with Resected Gallbladder Carcinoma: A Systematic Review and Meta-analysis. Ann Surg Oncol 2017; 25:255-264. [PMID: 29079926 DOI: 10.1245/s10434-017-6139-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND The impact of adjuvant radiotherapy (ART) on survival from gallbladder carcinoma (GBC) remains underexplored, with conflicting results reported. A systematic review and meta-analysis was performed to clarify the impact of ART in GBC. METHODS A systematic literature search of several databases was performed following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, from inception to August 2016. Studies that reported survival outcomes for patients with or without ART after curative surgery were included. RESULTS All the inclusion criteria was met by 14 retrospective studies including 9364 analyzable patients, but most of the studies had a moderate risk of bias. Generally, the ART group had more patients with unfavorable characteristics than the group that had surgery alone. Nevertheless, the pooled results showed that ART significantly reduced the risk of death (hazard ratio [HR], 0.54; 95% confidence interval [CI] 0.44-0.67; p < 0.001) and recurrence (HR 0.61; 95% CI 0.38-0.98; p = 0.04) of GBC compared with surgery alone. Exploratory analyses demonstrated a survival benefit from ART for a subgroup of patients with lymph node-positive diseases (HR 0.61; p < 0.001) and R1 resections (HR 0.55; p < 0.001), but not for patients with lymph node-negative disease (HR 1.06; p = 0.78). No evidence of publication bias was found (p = 0.663). CONCLUSIONS This study is the first meta-analysis to evaluate the role of ART and to provide supporting evidence that ART may offer survival benefits, especially for high-risk patients. However, further confirmation with a randomized prospective study is needed to clarify the subgroup of GBC patients who would benefit most from ART.
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Affiliation(s)
- Byoung Hyuck Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeanny Kwon
- Department of Radiation Oncology, Chungnam National University College of Medicine, Daejeon, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. .,Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea.
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha Womans University College of Medicine, Seoul, Korea.
| | - Young Hoon Kim
- Department of General Surgery, Dong-A University College of Medicine, Busan, Korea
| | - Dong Wan Seo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan Medical College, Seoul, Korea
| | - Amol K Narang
- Department of Radiation Oncology & Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Joseph M Herman
- Department of Radiation Oncology & Molecular Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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17
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Surgical Management of Gallbladder Cancer: Simple Versus Extended Cholecystectomy and the Role of Adjuvant Therapy. Ann Surg 2017; 266:625-631. [PMID: 28692469 DOI: 10.1097/sla.0000000000002385] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To assess if simple cholecystectomy with adjuvant therapy could provide outcomes comparable to extended cholecystectomy. BACKGROUND Current guidelines recommend extended/radical cholecystectomy for T2/T3 gallbladder cancer; however, many tumors are discovered incidentally at laparoscopic cholecystectomy. METHODS The national Cancer Data Base 2004 to 2014 was queried for patients with pT2/T3 gallbladder adenocarcinoma who underwent resection. Adjuvant therapy was defined as chemotherapy, with or without radiotherapy, within 90 days of surgery. Baseline characteristics and overall survival were compared by χ and Kaplan-Meier method, respectively. One-to-one propensity score matching for receipt of adjuvant therapy was used to account for potential selection bias. RESULTS A total of 6825 patients were identified. Diagnosis was made predominantly (78.9%) at the time of surgery or on pathology; 31.8% (2168) received adjuvant therapy. The majority, 88.8% (6060), had a simple cholecystectomy. Patients who received adjuvant therapy versus surgery alone were more likely to: be younger, privately insured, have no comorbidities, pT3 disease, positive lymph nodes, positive resection margins, and extended cholecystectomy. After matching, median survival was significantly longer for extended cholecystectomy with adjuvant therapy (23.3 months) than cholecystectomy with adjuvant therapy (16.4 months), which was significantly longer than either simple (12.4 months) or extended (10.7 months) cholecystectomy alone (all log-rank P<0.001). CONCLUSIONS Adjuvant therapy prolongs survival after resection of T2/T3 tumors. Simple cholecystectomy with adjuvant therapy appears to be superior to extended resection alone in the short term and may serve as a potential alternative to re-resection in select high-risk individuals.
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18
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Prabhu RS, Hwang J. Adjuvant therapy in biliary tract and gall bladder carcinomas: a review. J Gastrointest Oncol 2017; 8:302-313. [PMID: 28480069 PMCID: PMC5401863 DOI: 10.21037/jgo.2017.01.17] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 11/04/2016] [Indexed: 12/13/2022] Open
Abstract
Biliary tract carcinomas are relatively rare, but are increasingly diagnosed. They comprise several anatomically contiguous sites, so are often grouped together, but they do appear to represent distinct diseases, in part because of anatomical and surgical considerations. Complete upfront surgical resection is generally difficult because these cancers are often diagnosed at relatively advanced stages of disease. Thus, adjuvant therapy is often considered. This paper will review the evidence underpinning current recommendations for adjuvant therapy in biliary carcinomas.
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Affiliation(s)
- Roshan S Prabhu
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
| | - Jimmy Hwang
- Levine Cancer Institute, Carolinas HealthCare System, Charlotte, NC, USA
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19
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Rahman R, Simoes EJ, Schmaltz C, Jackson CS, Ibdah JA. Trend analysis and survival of primary gallbladder cancer in the United States: a 1973-2009 population-based study. Cancer Med 2017; 6:874-880. [PMID: 28317286 PMCID: PMC5387125 DOI: 10.1002/cam4.1044] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 12/18/2022] Open
Abstract
Primary gallbladder cancer is an aggressive and uncommon cancer with poor outcomes. Our study examines epidemiology, trend, and survival of gallbladder cancer in the United States from 1973 to 2009. We utilized the Surveillance Epidemiology and End Results database (SEER). Frequency and rate analyses on demographics, stage, and survival were compared among non-Hispanic whites, Hispanics, African American, and Asian/Pacific Islanders. A total of 18,124 cases were reported in SEER from 1973 to 2009 comprising 1.4% of all reported gastrointestinal cancers. Gallbladder cancer was more common in females than males (71 vs. 29%, respectively). The age-adjusted incidence rate was 1.4 per 100,000, significantly higher in females than males (1.7 vs. 1.0). Trend analysis showed that the incidence rate has been decreasing over the last three decades for males. However, among females, the incidence rate had decreased from 1973 to mid-90s but has remained stable since then. Trend analysis for stage at diagnosis showed that the proportion of late-stage cases has been increasing significantly since 2001 after a decreasing pattern since 1973. Survival has improved considerably over time, and survival is better in females than males and in Asian/Pacific Islanders than other racial groups. The highest survival was in patients who received both surgery and radiation. Trend analysis revealed a recent increase of the incidence of late-stage gallbladder cancer. Highest survival was associated with receiving both surgery and radiation.
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Affiliation(s)
- Rubayat Rahman
- Division of Gastroenterology and HepatologyUniversity of Missouri School of MedicineOne Hospital Drive, CE 405ColumbiaMissouri65212
| | - Eduardo J. Simoes
- Department of Health Management and InformaticsUniversity of Missouri School of MedicineOne Hospital DriveCE707 CS&E BldgColumbiaMissouri65212
| | - Chester Schmaltz
- Missouri Cancer Registry and Research CenterUniversity of Missouri at Columbia401 Clark HallColumbiaMissouri65211
| | | | - Jamal A. Ibdah
- Division of Gastroenterology and HepatologyUniversity of Missouri School of MedicineOne Hospital Drive, CE 405ColumbiaMissouri65212
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20
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Kim YS, Jeong CY, Song HN, Kim TH, Kim HJ, Lee YJ, Hong SC. The efficacy of fluoropyrimidine-based adjuvant chemotherapy on biliary tract cancer after R0 resection. CHINESE JOURNAL OF CANCER 2017; 36:9. [PMID: 28086990 PMCID: PMC5237216 DOI: 10.1186/s40880-017-0182-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 12/31/2016] [Indexed: 02/07/2023]
Abstract
Background The optimal treatment strategy for biliary tract cancer (BTC) after curative-intent resection remains controversial. The purpose of this study was to evaluate the efficacy of fluoropyrimidine-based adjuvant chemotherapy for BTC patients undergoing microscopically margin-negative (R0) resection. Methods We retrospectively analyzed the clinical data of BTC patients who underwent curative-intent R0 resection. Patients were eligible if they received either fluoropyrimidine-based adjuvant chemotherapy or observation after R0 resection. Results A total of 153 patients were included. In the entire patient cohort, no significant differences were observed in 5-year overall survival (OS) rates (48.4% vs. 39.6%, P = 0.439) or 3-year recurrence-free survival (RFS) rates (49.1% vs. 39.5%, P = 0.299) between patients who received fluoropyrimidine-based adjuvant chemotherapy or observation. However, for patients with stages II and III BTC, chemotherapy significantly improved 5-year OS rate (52.4% vs. 35.6%, P = 0.002) and 3-year RFS rate (55.5% vs. 39.1%, P = 0.021) compared with observation. Conclusion Fluoropyrimidine-based adjuvant chemotherapy may prolong the survival of patients with stages II and III BTC after R0 resection.
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Affiliation(s)
- Young Saing Kim
- Division of Hematology and Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, 405-706, South Korea
| | - Chi-Young Jeong
- Department of Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju, 660-702, South Korea.
| | - Haa-Na Song
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, 660-702, South Korea
| | - Tae Hyo Kim
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, 660-702, South Korea
| | - Hong Jun Kim
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, 660-702, South Korea
| | - Young-Joon Lee
- Department of Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju, 660-702, South Korea
| | - Soon Chan Hong
- Department of Surgery, Institute of Health Sciences, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, 79 Gangnam-ro, Jinju, 660-702, South Korea
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Mantripragada KC, Hamid F, Shafqat H, Olszewski AJ. Adjuvant Therapy for Resected Gallbladder Cancer: Analysis of the National Cancer Data Base. J Natl Cancer Inst 2016; 109:djw202. [PMID: 27707843 DOI: 10.1093/jnci/djw202] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/29/2016] [Indexed: 12/16/2022] Open
Abstract
Background Management of resected gallbladder cancer relies on single-arm trials and retrospective observations. Our objective was to evaluate adjuvant therapy in a nationwide data set using causal inference methods to address sources of bias. Methods We studied patients with T2-3 or node-positive, nonmetastatic gallbladder cancer, resected with grossly negative margins and reported to the National Cancer Data Base between 2004 and 2011. We defined adjuvant therapy as any chemotherapy within 90 days of surgery, and upfront concurrent chemoradiation as radiation within 14 days of first chemotherapy. After adjusting for missing data and guarantee-time bias, and using propensity score analysis to minimize indication bias, we compared overall survival of patients receiving adjuvant therapies with untreated case subjects. Results Adjuvant chemotherapy was administered to 28.8% of 4775 patients, and upfront chemoradiation to 13.5%. Treatment was less frequent among patients who were older, patients with comorbidities, and among white Hispanic women. T3 or node-positive disease, microscopically positive margins, or extended resection increased the likelihood of adjuvant therapy. Overall survival at three years was 39.9% (95% confidence interval [CI] = 38.4% to 41.4%) and was unaffected by adjuvant therapy after adjusting for multiple confounders (hazard ratio = 1.01, 95% CI = 0.92 to 1.10). Patients with T3 or node-positive tumors treated with upfront adjuvant chemoradiation had a modest early survival advantage (absolute difference at two years = 6.8%, 95% CI = 1.1% to 12.6%), but survival curves converged after five years of follow-up. Conclusions The curative potential of current adjuvant therapy in gallbladder cancer is questionable, justifying placebo-controlled investigation of novel chemotherapy combinations or alternative approaches. Chemoradiation may provide a short-term benefit in locally advanced tumors.
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Affiliation(s)
- Kalyan C Mantripragada
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA.,Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Fatima Hamid
- Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA.,Department of Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI, USA
| | - Hammad Shafqat
- Department of Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI, USA
| | - Adam J Olszewski
- Division of Hematology-Oncology, Rhode Island Hospital, Providence, RI, USA.,Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
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22
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Go SI, Kim YS, Hwang IG, Kim EY, Oh SY, Ji JH, Song HN, Park SH, Park JO, Kang JH. Is There a Role for Adjuvant Therapy in R0 Resected Gallbladder Cancer?: A Propensity Score-Matched Analysis. Cancer Res Treat 2016; 48:1274-1285. [PMID: 26875193 PMCID: PMC5080804 DOI: 10.4143/crt.2015.502] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2015] [Accepted: 01/28/2016] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The purpose of this study is to assess the role of adjuvant therapy in stage I-III gallbladder cancer (GBC) patients who have undergone R0 resection. MATERIALS AND METHODS Clinical data were collected on 441 consecutive patients who underwent R0 resection for stage I-III GBC. Eligible patients were classified into adjuvant therapy and surveillance only groups. Propensity score matching (PSM) between the two groups was performed, adjusting clinical factors. RESULTS In total, 84 and 279 patients treated with adjuvant therapy and followed up with surveillance only, respectively, were included in the analysis. Before PSM, the 5-year relapse-free survival (RFS) rate was lower in the adjuvant therapy group than in the surveillance only group (50.8% vs. 74.8%, p < 0.001), although there was no statistically significant difference in the 5-year overall survival (OS) rate (66.2% vs. 79.5%, p=0.089). After the PSM, baseline characteristics became comparable and there were no differences in the 5-year RFS (50.8% vs. 64.8%, p=0.319) and OS (66.2% vs. 70.4%, p=0.703) rates between the two groups. CONCLUSION The results suggest that fluoropyrimidine-based adjuvant therapy is not indicated in stage I-III GBC patients who have undergone R0 resection.
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Affiliation(s)
- Se-Il Go
- Division of Hematology/Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young Saing Kim
- Division of Hematology/Oncology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Korea
| | - In Gyu Hwang
- Division of Hematology/Oncology, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Eun Young Kim
- Department of Radiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Sung Yong Oh
- Division of Hematology/Oncology, Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Jun Ho Ji
- Division of Hematology/Oncology, Department of Internal Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Haa-Na Song
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Se Hoon Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joon Oh Park
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jung Hun Kang
- Division of Hematology/Oncology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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23
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Chang J, Jang JY, Lee KB, Kang MJ, Jung W, Shin YC, Kim SW. Improvement of clinical outcomes in the patients with gallbladder cancer: lessons from periodic comparison in a tertiary referral center. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2016; 23:234-41. [DOI: 10.1002/jhbp.330] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 01/02/2016] [Indexed: 12/21/2022]
Affiliation(s)
- Jihoon Chang
- Department of Surgery and Cancer Research Institute; Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744; Korea
| | - Jin-Young Jang
- Department of Surgery and Cancer Research Institute; Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744; Korea
| | - Kyoung Bun Lee
- Department of Pathology; Seoul National University College of Medicine; Seoul Korea
| | - Mee Joo Kang
- Department of Surgery and Cancer Research Institute; Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744; Korea
| | - Woohyun Jung
- Department of Surgery and Cancer Research Institute; Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744; Korea
| | - Yong Chan Shin
- Department of Surgery and Cancer Research Institute; Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744; Korea
| | - Sun-Whe Kim
- Department of Surgery and Cancer Research Institute; Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744; Korea
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24
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Wang J, Narang AK, Sugar EA, Luber B, Rosati LM, Hsu CC, Fuller CD, Pawlik TM, Miller RC, Czito BG, Tuli R, Crane CH, Ben-Josef E, Thomas CR, Herman JM. Evaluation of Adjuvant Radiation Therapy for Resected Gallbladder Carcinoma: A Multi-institutional Experience. Ann Surg Oncol 2015; 22 Suppl 3:S1100-S1106. [PMID: 26224402 PMCID: PMC9671536 DOI: 10.1245/s10434-015-4685-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Indexed: 08/10/2023]
Abstract
PURPOSE The role of adjuvant radiation for gallbladder carcinoma (GBC) is uncertain. We combine the experience of six National Cancer Institute-designated cancer centers to explore the impact of adjuvant radiation following oncologic resection of GBC. METHODS Patients who underwent extended surgery for GBC at Johns Hopkins, Mayo Clinic, Duke University, Oregon Health & Science University, University of Michigan, and University of Texas MD Anderson between 1985 and 2008 were reviewed. Patients with metastatic disease at surgery, gross residual disease, or missing pathologic information were excluded. RESULTS Of the 112 patients identified, 61 % received adjuvant radiation, 93 % of whom received concurrent chemotherapy. Median follow-up of surviving patients was 47.3 (range 2.2-167.7) months. Patients who received adjuvant radiation had a higher rate of advanced T-stage (57 vs. 16 %, p < 0.01), lymph node involvement (63 vs. 18 %, p < 0.01), and positive microscopic margins (37 vs. 9 %, p < 0.01) compared with patients managed with surgery alone, but overall survival (OS) was comparable between the two cohorts (5-year OS: 49.7 vs. 52.5 %, p = 0.20). Lymph node involvement had the strongest association with poor OS (p < 0.01). Adjuvant radiation was associated with decreased isolated local failure (hazard ratio 0.17, 95 % confidence interval 0.05-0.63, p = 0.01). However, 71 % of recurrences included distant failure. CONCLUSIONS Following oncologic resection for GBC, adjuvant radiation may offer improved local control compared with observation. The benefit of adjuvant radiation beyond chemotherapy alone should therefore be explored. Certainly, the high rate of distant failure highlights the need for more effective systemic therapy.
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Affiliation(s)
| | - Amol K Narang
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth A Sugar
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Brandon Luber
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lauren M Rosati
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles C Hsu
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- San Francisco School of Medicine, University of California, San Francisco, CA, USA
| | - Clifton D Fuller
- MD Anderson Cancer Center, Houston, TX, USA
- Uinversity of Texas Health Science Center, San Antonio, TX, USA
| | - Timothy M Pawlik
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | - Richard Tuli
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Edgar Ben-Josef
- University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Charles R Thomas
- Uinversity of Texas Health Science Center, San Antonio, TX, USA
- Oregon Health & Science University, Portland, OR, USA
| | - Joseph M Herman
- Department of Radiation Oncology & Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Hoehn RS, Wima K, Ertel AE, Meier A, Ahmad SA, Shah SA, Abbott DE. Adjuvant Therapy for Gallbladder Cancer: an Analysis of the National Cancer Data Base. J Gastrointest Surg 2015; 19:1794-801. [PMID: 26293376 DOI: 10.1007/s11605-015-2922-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 08/10/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The role of adjuvant therapy in patients with resected gallbladder cancer (GBC) is unclear. METHODS The American College of Surgeons National Cancer Data Base was used to identify patients with resected GBC (pathologic stage 1-3) from 1998 to 2006 (n = 6690). We compared three groups: surgery only (S, 78.6 %), surgery plus adjuvant chemotherapy (AC, 6.2 %), and surgery plus adjuvant chemotherapy and radiation therapy (ACR, 15.1 %). Univariate and Cox regression analyses were used to determine factors influencing overall survival and the use of adjuvant therapy. RESULTS ACR was associated with improved survival for all patients (HR 0.77, 95 % CI 0.66-0.90), especially node-positive patients (HR 0.64, 95 % CI 0.53-0.78); AC was not associated with changes in survival. Patients were less likely to have their lymph nodes examined if they had any comorbidities, lower income, or were treated at community cancer centers (all p < 0.05). Among patients with unknown lymph node status, those with T2 or T3 disease saw improved survival with ACR (T2: HR 0.79, 95 % CI 0.63-0.99; T3: HR 0.43, 95 % CI 0.30-0.62), while AC did not affect survival. CONCLUSION ACR is associated with improved survival for patients with node-positive GBC, as well as those with T2 or T3 GBC with unknown lymph node status.
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Affiliation(s)
- Richard S Hoehn
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Koffi Wima
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Audrey E Ertel
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Alexandra Meier
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Syed A Ahmad
- Division of Surgical Oncology, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA
| | - Shimul A Shah
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA
| | - Daniel E Abbott
- Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Department of Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA. .,Division of Surgical Oncology, University of Cincinnati School of Medicine, 231 Albert Sabin Way, ML 0558, Cincinnati, OH, 45267-0558, USA.
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Laparoscopic narrow band imaging for detection of occult cancer metastases: a randomized feasibility trial. Surg Endosc 2015; 30:1656-61. [PMID: 26194251 DOI: 10.1007/s00464-015-4401-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 07/01/2015] [Indexed: 10/25/2022]
Abstract
BACKGROUND Selection of cancer treatment fundamentally relies on staging of the underlying malignancy. The aim of this study was to evaluate the feasibility and effectiveness of laparoscopic narrow band imaging (NBI) for operative staging and detection of occult peritoneal cancer metastases. METHODS A randomized, controlled feasibility trial with crossover design evaluating adult patients with gastrointestinal or gynecologic malignancies who have a clinical indication for diagnostic laparoscopy was conducted. Twenty-three patients were randomized to white-light followed by NBI laparoscopy (n = 11) or NBI followed by white-light laparoscopy (n = 12) using the Olympus Evis Exera II system. Three patients were excluded from analysis. RESULTS In all 20 study patients, the abdominal cavity was sufficiently illuminated. An enhanced contrast of microvasculature and organ surface pattern was appreciated. Eight of the 20 patients (40%) were found to have metastases of the peritoneal surface. While NBI did not show any additional peritoneal lesions, 2 of the 63 suspicious-appearing nodules seen on white-light imaging were not visible on NBI (p = 0.50). The median diameter of all the nodules identified was 2 mm (range 1-50 mm) and was identical with each method. CONCLUSIONS The information from this feasibility study demonstrated that NBI provides adequate illumination of the abdominal cavity and a unique contrast that enhances microvasculature and architectural surface pattern. The results suggest that NBI laparoscopy is not superior in detecting peritoneal metastases compared to standard white-light laparoscopy, but might provide a technology that could be applied for other abdominal pathologies.
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27
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Serum vascular endothelial growth factors C and D as forecast tools for patients with gallbladder carcinoma. Tumour Biol 2015; 36:6305-12. [PMID: 25801241 PMCID: PMC4546698 DOI: 10.1007/s13277-015-3316-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 03/08/2015] [Indexed: 12/16/2022] Open
Abstract
Gallbladder carcinoma (GBC) is the most common cancer of the biliary tract. Lymph node metastasis (LNM) is the major diffusion route of GBC and is a prognosis factor. The aim of study was to assess the potential of the serum VEGF-C and VEGF-D (sVEGF-C/D) levels to predict the presence of LNM and the survival of GBC patients. The preoperative sVEGF-C/D levels of 31 patients with GBC, 10 patients with cholesterol polyps, and 10 healthy volunteers were measured by enzyme-linked immunoadsorbent assay (ELISA). The sVEGF-C/D levels of patients with GBC were significantly higher than those of people with healthy gallbladders (p < 0.001 and p = 0.001, respectively) and cholesterol polyp (p = 0.032 and p = 0.004, respectively). In GBC, the sVEGF-C levels were associated with LNM (p = 0.011), distant metastasis (p = 0.018), and stage (p = 0.045), but the sVEGF-D levels had a significant association with the tumor depth (p = 0.001), LNM (p = 0.001), distant metastasis (p = 0.047), and stage (p = 0.002). The sVEGF-C/D diagnostic values for the presence of GBC were sensitivity of 71.0 and 74.2 % and specificity of 80.0 and 85.0 %, respectively. With respect to the diagnosis of LNM, the diagnostic values of sVEGF-C/D were as follows: sensitivity 81.2 and 87.5 % and specificity 73.3 and 80.0 %, respectively. The mean survival time with high sVEGF-C was significantly shorter than that with low sVEGF-C (p < 0.001), which was also true for low sVEGF-D (p = 0.032). The preoperative sVEGF-C/D levels might be reliable biomarkers for the presence of disease and LNM in patients with GBC. The sVEGF-C/D levels may be prognosis factors that can predict a poor outcome for GBC patients.
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Abstract
OBJECTIVE Radical lymph node dissection in surgery for advanced gallbladder cancer is controversial. The purpose of this study is to evaluate the different extent of lymph node dissection for N2 stage gallbladder cancer patients. PATIENTS AND METHODS A retrospective analysis was made of 60 patients with N2 stage who underwent standard regional lymphadenectomy (SRLN) and extended regional lymphadenectomy (ERLN). Between September 2000 and June 2011, 60 advanced gallbladder cancer patients with N2 stage of lymph node metastasis were included in this study. The curative effects with different extent of lymphadenctomy for lymph node N2 stage of gallbladder cancer patients were compared. RESULTS The median survival time was 34.83 months in the SRLN group and 30.28 months in the ERLN group. There was no significant difference of survival rate between SRLN and ERLN group (P=0.51). Postoperative major morbidity and mortality rates were 64.3% and 7.14% in the SRLN group, 81.3% and 9.34% in the ERLN group, respectively. Moreover, the number of positive lymph nodes and chemotherapy were found to correlate with survival on univariate analyses (P<0.05). CONCLUSIONS For advanced gallbladder patients with N2 stage lymph node metastasis, ERLN cannot provide a significant survival benefit over SRLN and the rate of morbidity and mortality in ERLN is exceptionally high. ERLN therefore should not be considered in the advanced gallbladder cancers with N2 stage.
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Lee SE, Kim KS, Kim WB, Kim IG, Nah YW, Ryu DH, Park JS, Yoon MH, Cho JY, Hong TH, Hwang DW, Choi DW. Practical guidelines for the surgical treatment of gallbladder cancer. J Korean Med Sci 2014; 29:1333-40. [PMID: 25368485 PMCID: PMC4214932 DOI: 10.3346/jkms.2014.29.10.1333] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 07/24/2014] [Indexed: 02/05/2023] Open
Abstract
At present, surgical treatment is the only curative option for gallbladder (GB) cancer. Many efforts therefore have been made to improve resectability and the survival rate. However, GB cancer has a low incidence, and no randomized, controlled trials have been conducted to establish the optimal treatment modalities. The present guidelines include recent recommendations based on current understanding and highlight controversial issues that require further research. For T1a GB cancer, the optimal treatment modality is simple cholecystectomy, which can be carried out as either a laparotomy or a laparoscopic surgery. For T1b GB cancer, either simple or an extended cholecystectomy is appropriate. An extended cholecystectomy is generally recommended for patients with GB cancer at stage T2 or above. In extended cholecystectomy, a wedge resection of the GB bed or a segmentectomy IVb/V can be performed and the optimal extent of lymph node dissection should include the cystic duct lymph node, the common bile duct lymph node, the lymph nodes around the hepatoduodenal ligament (the hepatic artery and portal vein lymph nodes), and the posterior superior pancreaticoduodenal lymph node. Depending on patient status and disease severity, surgeons may decide to perform palliative surgeries.
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Affiliation(s)
- Seung Eun Lee
- Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Wan Bae Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - In-Gyu Kim
- Department of Surgery, Hallym University College of Medicine, Chuncheon, Korea
| | - Yang Won Nah
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Hee Ryu
- Department of Surgery, Chungbuk National University College of Medicine and Medical Research Institute, Cheongju, Korea
| | - Joon Seong Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Myung Hee Yoon
- Department of Surgery, Kosin University College of Medicine, Busan, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Tae Ho Hong
- Department of Surgery, Catholic University College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Department of Surgery, University of Ulsan College of Medicine, Ulsan, Korea
| | - Dong Wook Choi
- Department of Surgery, Sungkyunkwan University College of Medicine, Seoul, Korea
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Sirohi B, Singh A, Jagannath P, Shrikhande SV. Chemotherapy and targeted therapy for gall bladder cancer. Indian J Surg Oncol 2014; 5:134-41. [PMID: 25114467 DOI: 10.1007/s13193-014-0317-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 05/13/2014] [Indexed: 12/13/2022] Open
Abstract
Gall bladder cancer is a common cancer in the Ganges belt of North-eastern India. In view of incidental diagnosis of gall bladder cancer by physicians and surgeons, the treatment is not optimised. Most patients present in advanced stages and surgery remains the only option to cure. This review highlights the current evidence in advances in systemic therapy of gall bladder cancer.
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Affiliation(s)
- Bhawna Sirohi
- Department of Medical Oncology, TMC Tata Memorial Centre, Parel Mumbai, 400012 India
| | - Ashish Singh
- Department of Medical Oncology, TMC Tata Memorial Centre, Parel Mumbai, 400012 India
| | - P Jagannath
- Department of Surgical Oncology, Lilavati Hospital and Research centre, Tata Memorial Centre (TMC), Mumbai, India
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Williams TM, Majithia L, Wang SJ, Thomas CR. Defining the Role of Adjuvant Therapy: Cholangiocarcinoma and Gall Bladder Cancer. Semin Radiat Oncol 2014; 24:94-104. [DOI: 10.1016/j.semradonc.2014.01.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Hwang JP, Lim I, Na III, Cho EH, Kim BII, Choi CW, Lim SM. Prognostic Value of SUVmax Measured by Fluorine-18 Fluorodeoxyglucose Positron Emission Tomography with Computed Tomography in Patients with Gallbladder Cancer. Nucl Med Mol Imaging 2013; 48:114-20. [PMID: 24900151 PMCID: PMC4028469 DOI: 10.1007/s13139-013-0255-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 11/16/2013] [Accepted: 11/20/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study is to investigate the prognostic value of F-18 fluorodeoxyglucose (F-18 FDG) positron emission tomography (PET)/computed tomography (CT) in gallbladder cancer patients. METHODS From June 2004 to June 2010, a total of 50 patients with gallbladder cancer who underwent diagnostic staging with F-18 FDG PET/CT following curative or palliative treatments were retrospectively evaluated. For the analysis, all patients were classified by age, sex, maximum standardized uptake value (SUVmax), lymph node (LN) or distant metastasis, serum level of CA19-9 and CEA, type of treatment and American Joint Committee on Cancer (AJCC) stage. RESULTS The median survival for the 50 patients was 245 days and the median SUVmax in PET/CT was 8.3 (range, 0-19.7). Patients with SUVmax < 6 survived significantly longer than patients with SUVmax ≥ 6 (median 405 days vs 203 days, p = 0.0400). On Kaplan-Meier analysis, SUVmax (p = 0.0400), stage (p = 0.0001), CA19-9 (p = 0.013), CEA (p = 0.006), LN metastasis (p = 0.0001), distant metastasis (p = 0.0020), type of treatment (p = 0.0001) were significantly associated with overall survival. Multivariate analysis study revealed that the patients with lower SUVmax measured from initial staging PET/CT (p = 0.0380), no LN metastasis (p = 0.0260), a lower stage (p = 0.026) and curative treatment (p = 0.0005) had longer survivals. CONCLUSIONS The present study shows that SUVmax on F-18 FDG PET/CT can provide prognostic information in patients with gallbladder cancer.
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Affiliation(s)
- Jae Pil Hwang
- />Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul 139-706 Republic of Korea
| | - Ilhan Lim
- />Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul 139-706 Republic of Korea
- />Molecular Imaging Research Center, Korea Institute of Radiological and Medical Sciences (KIRAMS), Nowon Gu, Seoul Republic of Korea
| | - Im II Na
- />Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Nowon Gu, Seoul Republic of Korea
| | - Eung Ho Cho
- />Department of Internal Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), Nowon Gu, Seoul Republic of Korea
| | - Byung II Kim
- />Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul 139-706 Republic of Korea
- />Molecular Imaging Research Center, Korea Institute of Radiological and Medical Sciences (KIRAMS), Nowon Gu, Seoul Republic of Korea
| | - Chang Woon Choi
- />Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul 139-706 Republic of Korea
- />Molecular Imaging Research Center, Korea Institute of Radiological and Medical Sciences (KIRAMS), Nowon Gu, Seoul Republic of Korea
| | - Sang Moo Lim
- />Department of Nuclear Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences (KIRAMS), 75 Nowongil, Nowon Gu, Seoul 139-706 Republic of Korea
- />Molecular Imaging Research Center, Korea Institute of Radiological and Medical Sciences (KIRAMS), Nowon Gu, Seoul Republic of Korea
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Zhang LQ, Zhang XD, Xu J, Wan Y, Qu K, Zhang JY, Wang ZX, Wei JC, Meng FD, Tai MH, Zhou L, Liu C. Potential therapeutic targets for the primary gallbladder carcinoma: estrogen receptors. Asian Pac J Cancer Prev 2013; 14:2185-90. [PMID: 23725110 DOI: 10.7314/apjcp.2013.14.4.2185] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Gallbladder carcinoma, the most frequent malignant neoplasm of the biliary tract system, has always been considered to feature late clinical presentation and diagnosis, limited treatment options and an extremely poor prognosis. In recent years, while the incidence of gallbladder cancer has appeared to be on the increase, the available treatment methods have not greatly improved survival of the affected patients. Thus, exploring new therapeutic targets for this devastating disease is an urgent matter at present. Epidemical studies have demonstrated that the incidence of gallbladder carcinoma exhibits a distinct gender bias, affecting females two to three times more than males, pointing to crucial roles of estrogen. It is well known that estrogen acts on target tissues by binding to estrogen receptors (ERs), which are mainly divided into three subtypes, ERα, ERβ and ERγ. ERα and ERβ appear to have overlapping but also unique even opposite biological effects. As important pathogenic mediators, ERs have been considered to relate to several kinds of tumors. In gallbladder carcinoma tissue, ERs have been shown to be positively expressed, and ERs expression levels are associated with differentiation and prognosis of this cancer. Nevertheless, the exact mechanisms of estrogen inducing growth of gallbladder carcinoma remain poorly understood. On the base of the current investigations, we deduce that estrogen participates in promotion of gallbladder carcinoma by influencing the formation of gallstones, stimulating angiogenesis, and promoting abnormal proliferation. Since ERs mediate the carcinogenic actions of estrogen in gallbladder, and therapy targeting ERs may provide new directions for gallbladder carcinoma. Therefore, it should be stressed that ERs are potential therapeutic targets for gallbladder carcinoma.
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Affiliation(s)
- Ling-Qiang Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Medical College, Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
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Recent advances in systemic therapies and radiotherapy for gallbladder cancer. Surg Oncol 2013; 22:61-7. [PMID: 23290830 DOI: 10.1016/j.suronc.2012.12.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/08/2012] [Accepted: 12/02/2012] [Indexed: 01/26/2023]
Abstract
Adjuvant treatment is not routine following resection for gallbladder cancer as most regimens have low response rates. In the palliative setting, recent advances have been made regarding combination chemotherapies and both gemcitabine/cisplatin and gemcitabine/oxaliplatin appear to be superior to single-agent 5FU, which has very little efficacy in this disease. There are isolated reports of dramatic responses to targeted monoclonal agents. The role of radiotherapy has recently been revisited, however, its effectiveness when patients are adequately surgically treated remains to be demonstrated.
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Cereda S, Belli C, Reni M. Adjuvant treatment in biliary tract cancer: To treat or not to treat? World J Gastroenterol 2012; 18:2591-6. [PMID: 22690066 PMCID: PMC3369994 DOI: 10.3748/wjg.v18.i21.2591] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 04/05/2012] [Accepted: 04/12/2012] [Indexed: 02/06/2023] Open
Abstract
Biliary tract cancer is a rare malignant tumor. There is limited knowledge about biology and natural history of this disease and considerable uncertainty remains regarding its optimal diagnostic and therapeutic management. The role of adjuvant therapy is object of debate and controversy. Although resection is identified as the most effective and the only potentially curative treatment, there is no consensus on the impact of adjuvant chemotherapy and/or radiotherapy on the high incidence of disease recurrence and on survival. This is mainly due to the rarity of this disease and the consequent difficulty in performing randomized trials. The only two prospectively controlled trials concluded that adjuvant chemotherapy did not improve survival. Most of the retrospective trials, which had limited sample size and included heterogeneous patients population and non-standardized therapies, suggested a marginal benefit of chemoradiotherapy in reducing locoregional recurrence and an uncertain impact on survival. Well-designed multi-institutional randomized trials are necessary to clarify the role of adjuvant therapy. Two ongoing phase III trials may provide relevant information.
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Traitement médical des cholangiocarcinomes: de l’adjuvant au métastatique, du nouveau ? ONCOLOGIE 2012. [DOI: 10.1007/s10269-012-2135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Cho SY, Han SS, Park SJ, Kim YK, Kim SH, Woo SM, Lee WJ, Kim TH, Hong EK. T-category reflects the histopathologic characteristics of gallbladder cancer. Eur J Surg Oncol 2012; 38:537-42. [PMID: 22284345 DOI: 10.1016/j.ejso.2012.01.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 10/11/2011] [Accepted: 01/09/2012] [Indexed: 02/06/2023] Open
Abstract
AIMS Gallbladder (GB) cancer is a relatively uncommon gastrointestinal malignancy and is known to often result in unfavorable outcomes. Recent advances in aggressive surgical resection have improved the overall survival rate of patients with GB cancer. We aimed to evaluate the outcomes and prognostic factors of GB cancer following a surgical resection with curative intent. METHODS Between March 2001 and March 2009, 89 patients with GB cancer underwent surgical resection with curative intent at the National Cancer Center of Korea. We then conducted a retrospective analysis of clinicopathologic data. RESULTS Nineteen patients underwent simple cholecystectomy and 70 patients underwent extended cholecystectomy. Tumor-free resection margins were obtained in 84 cases. The 1-, 3- and 5-year disease-specific survival rates in the 89 patients were 85.8%, 68.0% and 64.1%, respectively. By multivariate analysis, only the T-category was significant (p < 0.001). The T-category showed a close correlation with all of the other histopathologic factors which were significant in univariate analysis. CONCLUSION The T-category of GB cancer represents not only the depth of the primary tumor but also the aggressiveness of its histopathologic nature.
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Affiliation(s)
- S Y Cho
- Center for Liver Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si, Gyeonggi-do 410 769, Republic of Korea
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Wang SJ, Lemieux A, Kalpathy-Cramer J, Ord CB, Walker GV, Fuller CD, Kim JS, Thomas CR. Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer. J Clin Oncol 2011; 29:4627-32. [PMID: 22067404 PMCID: PMC3236647 DOI: 10.1200/jco.2010.33.8020] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 07/18/2011] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Although adjuvant chemoradiotherapy for resected gallbladder cancer may improve survival for some patients, identifying which patients will benefit remains challenging because of the rarity of this disease. The specific aim of this study was to create a decision aid to help make individualized estimates of the potential survival benefit of adjuvant chemoradiotherapy for patients with resected gallbladder cancer. METHODS Patients with resected gallbladder cancer were selected from the Surveillance, Epidemiology, and End Results (SEER) -Medicare database who were diagnosed between 1995 and 2005. Covariates included age, race, sex, stage, and receipt of adjuvant chemotherapy or chemoradiotherapy (CRT). Propensity score weighting was used to balance covariates between treated and untreated groups. Several types of multivariate survival regression models were constructed and compared, including Cox proportional hazards, Weibull, exponential, log-logistic, and lognormal models. Model performance was compared using the Akaike information criterion. The primary end point was overall survival with or without adjuvant chemotherapy or CRT. RESULTS A total of 1,137 patients met the inclusion criteria for the study. The lognormal survival model showed the best performance. A Web browser-based nomogram was built from this model to make individualized estimates of survival. The model predicts that certain subsets of patients with at least T2 or N1 disease will gain a survival benefit from adjuvant CRT, and the magnitude of benefit for an individual patient can vary. CONCLUSION A nomogram built from a parametric survival model from the SEER-Medicare database can be used as a decision aid to predict which gallbladder patients may benefit from adjuvant CRT.
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Affiliation(s)
- Samuel J Wang
- Oregon Health & Science University, Portland, 97239-3098, USA.
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Incidental gallbladder cancer: what management? Oncol Rev 2011. [DOI: 10.1007/s12156-011-0092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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Choi KK, Choi SB, Park SW, Kim HK, Park YN, Kim KS. Synchronous double primary cancers associated with a choledochal cyst and anomalous pancreaticobiliary ductal union. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2011; 81:281-6. [PMID: 22111085 PMCID: PMC3219855 DOI: 10.4174/jkss.2011.81.4.281] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Revised: 01/19/2011] [Accepted: 02/07/2011] [Indexed: 12/21/2022]
Abstract
A 60-year-old female was admitted with epigastric pain lasting a month. Preoperative diagnosis was choledochal cyst with anomalous pancreaticobiliaryductal union (APBDU), C-P type. A papillary mass measuring 2.5 × 1.9 cm was found adjacent to the pancreaticocholedochal junction. Gallbladder (GB) cancer was also observed. Pyloric-preserving pancreaticoduodenectomy (PPPD) was performed. The patient received adjuvant chemotherapy/radiation therapy on the tumor bed. The gallbladder cancer showed serosal invasion, while the bile duct cancer extended into the pancreas. Although common bile duct (CBD) cancer lesion showed focally positive for p53 and the gallbladder cancer lesion showed negative for p53, the Ki-67 labeling index of the CBD cancer and GB cancer were about 10% and 30%, respectively. Nine months after curative resection, a stricture on the subhepatic colon developed due to adjuvant radiation therapy. Localized peritoneal seedings were incidentally found during a right hemicolectomy. The patient underwent chemotherapy and had no evidence of tumor recurrence for two years after PPPD.
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Affiliation(s)
- Kang Kook Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Sun XN, Cao WG, Wang X, Wang Q, Gu BX, Yang QC, Hu JB, Liu H, Zheng S. Prognostic impact of vascular endothelial growth factor-A expression in resected gallbladder carcinoma. Tumour Biol 2011; 32:1183-90. [PMID: 21853312 DOI: 10.1007/s13277-011-0221-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 08/05/2011] [Indexed: 12/11/2022] Open
Abstract
The purpose of this study was to evaluate the value of vascular endothelial growth factor-A (VEGF-A) expression and other confirmed prognostic factors in predicting clinical outcomes after the resection of gallbladder carcinoma (GBC). Between January 1999 and January 2006, a total of 84 consecutive and non-selected patients who underwent resection for GBC were retrospectively reviewed. Of the 84 patients studied, 45 cases (53.6%) exhibited high expression of VEGF-A and were placed into the high expression group. The 14 cases (16.7%) that showed no VEGF expression and the 25 cases (29.7%) that had lower VEGF-A levels were pooled into the low expression group (46.4%). There was a relationship between VEGF-A status and pM stage (P = 0.027) as well as histologic differentiation (P < 0.001). In univariate analysis by log-rank test, ECOG performance status, CA 19-9, pN stage, pM stage, histologic differentiation, and VEGF-A expression were significant prognostic factors (P = 0.015, 0.001, 0.020, <0.001, 0.040, and <0.001, respectively). Multivariate analysis revealed that pN status and VEGF-A expression maintained independent prognostic influence on overall survival (P < 0.001 and P = 0.013, respectively). VEGF-A expression has a positive correlation with pM stage and histologic differentiation. pN status and VEGF-A expression were independent prognostic factors of overall survival in patients with resected GBC.
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Affiliation(s)
- Xiao-Nan Sun
- Department of Radiation Oncology of Sir Run Run Shaw Hospital, Sir Run Run Shaw Institute of Clinical Medicine of Zhejiang University, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, China
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Kim S, Kim K, Chie EK, Kim SW, Bang YJ, Ha SW. Treatment outcomes and prognostic factors of gallbladder cancer patients after postoperative radiation therapy. KOREAN JOURNAL OF HEPATO-BILIARY-PANCREATIC SURGERY 2011; 15:152-6. [PMID: 26421032 PMCID: PMC4582537 DOI: 10.14701/kjhbps.2011.15.3.152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2011] [Revised: 07/12/2011] [Accepted: 08/14/2011] [Indexed: 11/17/2022]
Abstract
Backgrounds/Aims To investigate survival rates and prognostic factors of patients with gallbladder cancer who were treated with surgery and postoperative radiation therapy. Methods Seventeen gallbladder cancer patients who received surgery and postoperative radiotherapy from October 1989 to April 1998 were included in this retrospective study. Five patients had stage II, 8 patients had stage III, and 4 patients had stage IV disease according to the 1997 American Joint Committee on Cancer (AJCC) staging. All patients received ≥40 Gy of postoperative radiotherapy with a daily dose of 2.0 Gy/fraction and 15 patients received concurrent chemotherapy. An analysis was performed for the end-points of overall and disease-free survival. Results Of the 17 patients, 13 had no residual disease (R0), 1 had microscopic residual disease (R1), and 3 had macroscopic residual disease (R2) after surgery. Among patients with no residual disease, 4 had locoregional recurrences during the follow-up period. One patient with microscopic residual disease had local recurrence. The 5-year overall survival rate was 38.2%. The median overall survival time was 21 months and the median disease-free survival time was 12 months. Old age (≥60 years old), female gender, a high pathological stage (≥IVA), and the presence of residual disease after surgery were significant prognostic factors for disease-free survival. Conclusions Despite a high proportion of patients with advanced disease and macroscopic residual disease, the prognosis of gallbladder patients who had postoperative radiotherapy is encouraging. Additional investigation to improve the loco-regional control of gallbladder cancer patients with adverse prognostic factors is warranted.
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Affiliation(s)
- Suzy Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
| | - Sun Whe Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Whan Ha
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. ; Institute of Radiation Medicine, Medical Research Center, Seoul National University, Seoul, Korea
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Meng H, Wang X, Fong Y, Wang ZH, Wang Y, Zhang ZT. Outcomes of radical surgery for gallbladder cancer patients with lymphatic metastases. Jpn J Clin Oncol 2011; 41:992-8. [PMID: 21712255 DOI: 10.1093/jjco/hyr072] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The objective of this study was to investigate whether radical surgical treatment can be associated with reasonable survival for patients with Stage IV gallbladder cancer with distant lymph node metastasis. METHODS Fifty-five patients (20 men and 35 women) with complete clinical and follow-up data for Japanese Society of Biliary Surgery TNM system Stage IV gallbladder cancer were included in our study. Patients were divided into three treatment groups for clinical analysis: Group A (radical resection, n = 24), Group B (chemotherapy, n = 8) and Group C (other palliative treatment, n = 23). RESULTS The survival rate in Group A was significantly higher when compared with Groups B (P=0.008) and C (P=0.004). Moreover, the prognosis of patients with distant lymph node metastasis (Group A2, Japanese Society of Biliary Surgery N3; American Joint Committee on Cancer M1) was significantly worse versus those with local lymph node metastasis (Group A1, Japanese Society of Biliary Surgery N1-N2; American Joint Committee on Cancer N1) (P=0.007). Most importantly, no significant difference in the survival rate was observed between patients in Group A2 and Groups B (P = 0.47) or C (P = 0.74). CONCLUSIONS Radical resection might result in a reasonable prognosis for gallbladder cancer patients with local metastasis of the lymph nodes (Japanese Society of Biliary Surgery N1-N2), but was not effective when distant lymph nodes (Japanese Society of Biliary Surgery N3) were involved.
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Affiliation(s)
- Hua Meng
- Department of Surgery, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Lu Road, Xuanwu District, Beijing 100050, China
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Negi SS, Singh A, Chaudhary A. Lymph nodal involvement as prognostic factor in gallbladder cancer: location, count or ratio? J Gastrointest Surg 2011; 15:1017-25. [PMID: 21487831 DOI: 10.1007/s11605-011-1528-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 03/29/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Lymph nodal involvement is a critical prognostic factor in patients with gallbladder cancer (GBC). Controversy exists regarding optimal categorization of nodal status, and no study has investigated the relevance of metastatic to examined nodes ratio (LNR) in these patients. METHODS Demographic, operative and pathologic data including total lymph node count (TLNC), positive lymph node count (PLNC), LNR and involved nodal location was recorded in 57 patients with GBC who underwent curative intent resection. Disease-free survival (DFS) and predictors of outcome were analyzed. RESULTS At a median follow-up of 19 (i.q.r: 11-39.5) months, median DFS was 28.25 ± 3.62 months and 35 (61%) patients had developed recurrence. Thirty-three (58%) patients had nodal involvement, and a linear correlation was observed between TLNC and PLNC (r (2) = 0.249, p < 0.001). Optimal TLNC and LNR were determined to be 6 and 0.50, respectively. Patients with negative nodes (N0) were better sub-stratified based on TLNC (median DFS, TLNC ≥ 6 vs. TLNC < 6: not reached vs. 32.00 ± 4.80 months, p = 0.012). Amongst patients with involved nodes, LNR was significantly associated with DFS (median DFS, 0 < LNR ≤ 0.50 vs. LNR > 0.50: 14.00 ± 2.46 vs. 9.00 ± 1.55 months, p < 0.001). Prognosis was not related to location of involved nodes. Multivariable analysis revealed T stage, tumor differentiation and LNR to be independent predictors of DFS. CONCLUSIONS LNR is a strong predictor of outcome after curative resection for GBC. The retrieval and examination of at least 6 nodes can influence staging quality and DFS in node-negative patients.
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Affiliation(s)
- Sanjay Singh Negi
- Department of Surgical Gastroenterology and Liver Transplantation, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi, 110060, India
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Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, Sakabe R, Kobayashi H, Sueda T. Prognostic factors of patients with advanced gallbladder carcinoma following aggressive surgical resection. J Gastrointest Surg 2011; 15:1007-16. [PMID: 21547707 DOI: 10.1007/s11605-011-1479-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/27/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognosis for patients with advanced gallbladder carcinoma is dismal despite aggressive surgical resection. The aim of this study is to determine useful prognostic factors for patients with gallbladder carcinoma following aggressive surgical resection. METHODS Medical records of 62 patients with gallbladder carcinoma who underwent surgical resection were retrospectively reviewed. Univariate and multivariate models were used to analyze the effect of clinicopathological factors on long-term survival. RESULTS According to the UICC staging system, ten (16%), 11 (18%), eight (13%), 16 (25%), nine (15%), and eight patients (13%) were diagnosed with stages I, II, IIIA, IIIB, IVA, and IVB disease, respectively. Partial hepatectomy and pancreatoduodenectomy were performed for 43 (69%) and 11 (18%) patients, respectively. Overall survival rates of all 62 and 41 patients with UICC stages III and IV disease were 71% and 56% at 1 year, 48% and 23% at 3 years, and 48% and 23% at 5 years, respectively (median survival time, 15.8 and 12.7 months, respectively). Multivariate analysis revealed that independent prognostic factors included tumor differentiation (p = 0.006), hepatic invasion (p = 0.002), lymph node metastasis (p = 0.009), and surgical margin status (p = 0.002) for all patients, and adjuvant chemotherapy (p = 0.005), tumor differentiation (p = 0.008), hepatic invasion (p = 0.001), and surgical margin status (p = 0.022) for patients with UICC stages III and IV disease. CONCLUSIONS R0 resection and adjuvant chemotherapy are significant prognostic factors in advanced gallbladder carcinoma and should be performed to improve survival.
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Affiliation(s)
- Yoshiaki Murakami
- Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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