1
|
Xie C, Shi D, Lin H, Liu Y, Liu W, Yin P. Spatial Patterns of Gallbladder and Biliary Tract Carcinoma in China From 1990 to 2019: An Analysis at the Provincial Level. Cureus 2023; 15:e42796. [PMID: 37664386 PMCID: PMC10469984 DOI: 10.7759/cureus.42796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Background Despite a high rate of fatal malignancy, little is known regarding the spatial and temporal patterns of the disease burden of gallbladder and biliary tract carcinoma in China, especially at the provincial level. Methodology Using data from the 2019 Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the temporal trend of the disease burden of gallbladder and biliary tract carcinoma from 1990 to 2019 as well as its incidence, mortality, prevalence, and disability-adjusted life-years (DALYs). We estimated the spatial pattern of the disease burden of gallbladder and biliary tract carcinoma at the provincial level. Results The disease burden of gallbladder and biliary tract carcinoma significantly increased from 1990 to 2019 in China. The age-standardized incidence, prevalence, mortality, and DALYs increased by 28.3%, 50.5%, 13.0%, and 7.0%, respectively. The disease burden of gallbladder carcinoma revealed substantial heterogeneity at the provincial level with a higher disease burden in developed provinces or cities than in developing provinces. The disease burden of gallbladder and biliary tract carcinoma was also heavier among males than among females (e.g., age-standardized DALYs: 42.60 per 100,000 people among males vs. 33.57 per 100,000 people among females in 2019). Conclusions The disease burden of gallbladder and biliary tract carcinoma has shown rapid changes during the past three decades, with a higher burden in economically advantaged regions than in disadvantaged regions in China. New public health policies and initiatives are needed to address this rising disease burden.
Collapse
Affiliation(s)
- Chuanbo Xie
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, CHN
| | - Di Shi
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, CHN
| | - Hualiang Lin
- Department of Epidemiology, Sun Yat-sen University, Guangzhou, CHN
| | - Yuying Liu
- Cancer Prevention Center, Sun Yat-sen University Cancer Center, Guangzhou, CHN
| | - Wei Liu
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, CHN
| | - Peng Yin
- National Center for Chronic and Noncommunicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, CHN
| |
Collapse
|
2
|
Value of Multislice Spiral CT in Differential Diagnosis of Thick-Wall Gallbladder Carcinoma and Chronic Cholecystitis. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:5459779. [PMID: 35601565 PMCID: PMC9106503 DOI: 10.1155/2022/5459779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/17/2022]
Abstract
To summarize the value of multislice spiral CT (MSCT) in the differential diagnosis of thick-wall gallbladder carcinoma (TWGC) and chronic cholecystitis (CC), the clinical data of 36 patients with TWGC and 60 patients with chronic cholecystitis who were treated in our hospital from January 2017 to May 2021 were retrospectively analyzed, and the CT image features and diagnostic accuracy of the patients were summarized. Compared with the CC group, the proportions of disruption of gallbladder mucosa line, blurred gallbladder outline, high obstruction of biliary tract, lymphomegaly, adjacent invasion, peritoneal effusion, wall nodules, and the gallbladder wall thickness in the TWGC group were higher, with statistical significance (P < 0.05). Thirty-four patients with TWGC and 62 patients with chronic cholecystitis were diagnosed by MSCT. The sensitivity and specificity of MSCT in diagnosing TWGC were 86.11% and 95.00%, respectively. The positive likelihood ratio was 17.222 and the negative likelihood ratio was 0.1462. The positive prediction rate was 91.18%, the negative prediction rate was 91.94%, and the correct rate was 91.67%. MSCT can show the characteristic difference between TWGC and chronic cholecystitis, which can be used for differential diagnosis.
Collapse
|
3
|
J V, Mishra D, Meher D, Dash S, Besra K, Pattnaik N, Singh SP, Dixit M. Genetic association of MMP14 promoter variants and their functional significance in gallbladder cancer pathogenesis. J Hum Genet 2021; 66:947-956. [PMID: 33727629 DOI: 10.1038/s10038-021-00917-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022]
Abstract
Gallbladder cancer (GBC) is relatively rare but shows high frequency in certain geographical regions and ethnic groups, which include Northern and Eastern states of India. Previous studies in India have indicated the possible role of genetic predisposition in GBC pathogenesis. Although matrix metalloproteinase-14 (MMP14) is known modulator of tumour microenvironment and tumorigenesis and TCGA data also suggests its upregulation yet, its role in genetic predisposition for GBC is completely unknown. We explored MMP14 promoter genetic variants as risk factors and their implication in expression modulation and the pathogenesis of GBC. We genotyped all single nucleotide polymorphisms of MMP14 promoter by Sanger's sequencing in approximately 300 GBC and 300 control study subjects of Indian ethnicity and, in 26 GBC tissue samples. Protein expression of MMP14 in GBC tissue samples was checked by immunohistochemistry. In vitro luciferase reporter assay was carried out to elucidate role of promoter genetic variants on expression levels in two different cell lines. MMP14 promoter variants, rs1003349 (p value = 0.0008) and rs1004030 (p value = 0.0001) were significantly associated with GBC. Luciferase reporter assay showed high expression for risk alleles of both the SNPs. Genotype-phenotype correlation for rs1003349 and rs1004030, in patient sample, confirmed that risk allele carriers had higher expression levels of MMP14; moreover, the correlation pattern matched with genetic association models. Overall, this study unravels the association of MMP14 promoter SNPs with GBC which contribute to pathogenesis by increasing its expression.
Collapse
Affiliation(s)
- Vinay J
- National Institute of Science Education and Research, School of Biological Sciences, Bhubaneswar, Odisha, India.,Homi Bhabha National Institute, Mumbai, India
| | - Debakanta Mishra
- Department of Gastroenterology, Sriram Chandra Bhanja Medical College & Hospital, Cuttack, Odisha, India
| | - Dinesh Meher
- Department of Gastroenterology, Sriram Chandra Bhanja Medical College & Hospital, Cuttack, Odisha, India
| | - Sashibhusan Dash
- Department of Pathology, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, Odisha, India
| | - Kusumbati Besra
- Department of Pathology, Acharya Harihar Post Graduate Institute of Cancer, Cuttack, Odisha, India
| | | | - Shivaram Prasad Singh
- Department of Gastroenterology, Sriram Chandra Bhanja Medical College & Hospital, Cuttack, Odisha, India
| | - Manjusha Dixit
- National Institute of Science Education and Research, School of Biological Sciences, Bhubaneswar, Odisha, India. .,Homi Bhabha National Institute, Mumbai, India.
| |
Collapse
|
4
|
The Prognostic Value of the CA19-9/TBIL Ratio in Patients with Biliary Tract Cancers (BTCs): A Retrospective Study. JOURNAL OF ONCOLOGY 2021; 2021:5829893. [PMID: 33688345 PMCID: PMC7925024 DOI: 10.1155/2021/5829893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 11/18/2022]
Abstract
Background Incidence of biliary tract cancers (BTCs) in China is high, and surgery is the only curative option. Preoperative CA19-9 has been identified as a predictor for survival in patients with resectable BTCs, but more potential predictors need to be studied. This retrospective study aimed to establish the prognostic significance of CA19-9/TBIL ratio (CTR) in patients with BTCs. Methods A retrospective analysis was performed in patients who were diagnosed with BTCs and received surgical resection between 2013 and 2018 at PUMCH. Demographic and clinical parameters were collected. Preoperative CA19-9 and CTR were classified as elevated (>58.6 and >0.83) according to the receiver operating characteristic (ROC) analysis. Demographic and clinical parameters were compared between the groups using Student's t-test, chi-square, or Fisher's exact test. Survival analysis was performed by the Kaplan-Meier methods, and the relationship between variables and survival was assessed by the log-rank test. Cox regression analysis was conducted to identify potential risk factors for overall survival. Results In total, 109 participants were involved in the final analysis. The overall survival rate was 18.0% at 5 years, with a median survival duration of 1.58 years. The Kaplan-Meier analysis indicated that higher CTR was associated with shorter OS (15 vs. 50, p < 0.01). Univariate survival analysis identified TNM staging, CA19-9, and CTR as statistically significant prognostic factors. In a multiple Cox analysis, only CTR was proved as a significantly independent prognostic factor. Conclusion CTR acts as an independent prognostic predictor for patients with biliary tract cancer.
Collapse
|
5
|
Xu L, Tan H, Liu X, Huang J, Liu L, Si S, Sun Y, Zhou W, Yang Z. Survival benefits of simple versus extended cholecystectomy and lymphadenectomy for patients with T1b gallbladder cancer: An analysis of the surveillance, epidemiology, and end results database (2004 to 2013). Cancer Med 2020; 9:3668-3679. [PMID: 32233076 PMCID: PMC7286443 DOI: 10.1002/cam4.2989] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/17/2020] [Accepted: 03/01/2020] [Indexed: 12/12/2022] Open
Abstract
Although guidelines recommend extended surgical resection, radical resection and lymphadenectomy for patients with tumor stage (T)1b gallbladder cancer, these procedures are substantially underutilized. This population‐based, retrospective cohort study aimed to evaluate treatment patterns and outcomes of 401 patients using the US Surveillance, Epidemiology, and End Results (SEER) database from 2004 to 2013. Results showed that median overall survival (OS) was 69 months for lymphadenectomy patients and 37 months for those without lymphadenectomy. Lymphadenectomy also tended to prolong cancer‐specific survival (CSS), although the differences were not statistically significant. OS and CSS were similar for patients who received simple cholecystectomy and extended surgical resection. Cox proportional hazards regression models revealed survival advantages in patients with stage T1bN0 gallbladder cancer compared to those with stage T1bN1, and patients who received simple cholecystectomy plus lymphadenectomy compared to those who did not receive lymph node dissection. In further analyses, patients undergoing simple cholecystectomy who had five or more lymph nodes excised had better OS and CSS than those without lymph node dissection. In conclusion, survival advantages are shown for patients with T1b gallbladder cancer undergoing surgeries with lymphadenectomy. Future studies with longer follow‐up and control of potential confounders are highly warranted.
Collapse
Affiliation(s)
- Li Xu
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Haidong Tan
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Xiaolei Liu
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Jia Huang
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Liguo Liu
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Shuang Si
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Yongliang Sun
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Wenying Zhou
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| | - Zhiying Yang
- Department of Hepatobiliary and Pancreatic Surgery, China-Japan Friendship Hospital, Beijing, China
| |
Collapse
|
6
|
Feng F, Huang C, Xiao M, Wang H, Gao Q, Chen Z, Xu X, Zhou J, Li F, Li Y, Zhang D, Chang Y, Jiang X. Establishment and characterization of patient-derived primary cell lines as preclinical models for gallbladder carcinoma. Transl Cancer Res 2020; 9:1698-1710. [PMID: 35117518 PMCID: PMC8798768 DOI: 10.21037/tcr.2020.02.04] [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: 08/29/2019] [Accepted: 01/18/2020] [Indexed: 01/18/2023]
Abstract
Background Gallbladder carcinoma (GBC) is one of the most lethal malignancies which do not have a targeted drug in the clinic. Patient-derived primary cell lines (PDCs) are useful in assessment of cancer complexity and heterogeneity, drug-sensitivity tests, and personalized-drug-selection guidance. The aim of this study is to establish GBC PDCs and characterize their biological features. Methods The characterization of PDCs was defined by morphology, growth kinetics, chromosomal analysis, short tandem repeat (STR) analysis, RNA-seq and tumorigenicity. Glycosylation of PDCs derived from GBC was first studied, and the PDC model’s performance were also tested and evaluated using seven molecular target inhibitors. Results Three novel GBC cell lines from three GBC patients were successfully established and denoted as JXQ-3D-902R4, JXQ-3D-4494R, and JXQ-3D-4786R. These cell lines demonstrated the heterogeneous characteristics of tumor morphology and phenotypes which are consistent with primary GBC, such as irregular cell shape, varied chromosomal numbers, and different STR patterns. Moreover, the growth activity and tumorigenicity ability varied among the cell lines, of which JXQ-3D-4494R exhibited the best growth rate. Furthermore, glycan profiling of whole proteins were detected and characterized. Unique N-glycans of each PDC were identified, JXQ-3D-902R4, JXQ-3D-4494R and JXQ-3D-4786R contained ten, four and seven unique glycans, respectively. The epithelial origins of three PDCs were confirmed using RNA-seq based on the highly expressed typical epithelial marker genes. Moreover, the drug-sensitivity results demonstrated that the three PDCs exhibited different responses to the seven-most commonly used targeted medicines belonging to three groups: cell-cycle inhibitors, PI3K/AKT/mTOR signaling-pathway inhibitors, and ErbB inhibitors. JXQ-3D-4494R was sensitive to most of the inhibitors, JXQ-3D-4786R was sensitive to ErbB inhibitors, and JXQ-3D-902R4 was sensitive to PI3K/AKT/mTOR inhibitors. Conclusions These results indicate that PDCs may be efficient preclinical models for further investigation of the biological behaviors and potential targeted therapies of human GBC.
Collapse
Affiliation(s)
- Feiling Feng
- Department of Biliary I, Shanghai Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai 200438, China
| | - Chuncui Huang
- Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Mingjia Xiao
- Department of Biliary I, Shanghai Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai 200438, China
| | - Huizhen Wang
- Research and Development Institute of Precision Medicine, 3D Medicines Inc., Shanghai 201114, China
| | - Qingxiang Gao
- Department of Biliary I, Shanghai Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai 200438, China
| | - Zishuo Chen
- Research and Development Institute of Precision Medicine, 3D Medicines Inc., Shanghai 201114, China
| | - Xiaoya Xu
- Research and Development Institute of Precision Medicine, 3D Medicines Inc., Shanghai 201114, China
| | - Jun Zhou
- Research and Development Institute of Precision Medicine, 3D Medicines Inc., Shanghai 201114, China
| | - Fugen Li
- Research and Development Institute of Precision Medicine, 3D Medicines Inc., Shanghai 201114, China
| | - Yan Li
- University of Chinese Academy of Sciences, Beijing 100049, China
| | - Dadong Zhang
- Research and Development Institute of Precision Medicine, 3D Medicines Inc., Shanghai 201114, China
| | - Yanxin Chang
- Biliary Tract Surgery Department, Shanghai Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai 200438, China
| | - Xiaoqing Jiang
- Department of Biliary I, Shanghai Eastern Hepatobiliary Surgery Hospital, Navy Military Medical University, Shanghai 200438, China
| |
Collapse
|
7
|
Huang S, Wang H, Chen W, Zhan M, Xu S, Huang X, Lin R, Shen H, Wang J. Tamoxifen inhibits cell proliferation by impaired glucose metabolism in gallbladder cancer. J Cell Mol Med 2019; 24:1599-1613. [PMID: 31782270 PMCID: PMC6991689 DOI: 10.1111/jcmm.14851] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 10/27/2019] [Accepted: 11/02/2019] [Indexed: 02/05/2023] Open
Abstract
Gallbladder cancer (GBC) is the leading malignancy of biliary system showing refractory chemoresistance to current first‐line drugs. Growing epidemiological evidences have established that the incidence of GBC exhibits significant gender predominance with females two‐threefold higher than males, suggesting oestrogen/oestrogen receptors (ERs) signalling might be a critical driver of tumorigenesis in gallbladder. This study aims to evaluate the antitumour activity of tamoxifen (TAM), a major agent of hormonal therapy for breast cancer, in preclinical GBC model. Quantitative real‐time PCR was used to investigate mRNA levels. Protein expression was measured by immunohistochemistry and Western blot. Glycolytic levels were measured by glucose consumption and lactic acid measurement. The antitumour activity of TAM alone or with cisplatin was examined with CCK8 assay, colony formation, flow cytometry and in vivo models. The results revealed that ERɑ expression was higher in GBC tissues and predicted poor clinical outcomes. TAM was showed effective against a variety of GBC cell lines. Mechanical investigations revealed that TAM enabled potent reactive oxygen species (ROS) production by reduced nuclear factor Nrf2 expression and its target genes, leading to the activation of AMPK, which subsequently induced impaired glycolysis and survival advantages. Notably, TAM was demonstrated to sensitize GBC cells to cisplatin (CDDP) both in vitro and in vivo. In agreement with these findings, elimination of oestrogens by ovariectomy in nude mice prevented CDDP resistance. In summary, these results provide basis for TAM treatment for GBC and shed novel light on the potential application of endocrine therapy for patients with GBC.
Collapse
Affiliation(s)
- Shuai Huang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Wang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Chen
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ming Zhan
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Sunwang Xu
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xince Huang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ruirong Lin
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hui Shen
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Wang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| |
Collapse
|
8
|
Zheng P, Wang X, Hong Z, Shen F, Zhang Q. Preoperative fasting hyperglycemia is an independent prognostic factor for postoperative survival after gallbladder carcinoma radical surgery. Cancer Manag Res 2019; 11:1425-1432. [PMID: 30863153 PMCID: PMC6388958 DOI: 10.2147/cmar.s192273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Preoperative high blood glucose levels are closely associated with poor performance and high mortality in cancer patients. This study was designed to investigate the relationship between preoperative fasting hyperglycemia and the prognosis of patients with gallbladder cancer (GBC) after undergoing GBC radical surgery. PATIENTS AND METHODS A retrospective analysis of 83 eligible patients who underwent GBC radical surgery between 2007 and 2016 was performed. Factors affecting overall survival (OS) and recurrence-free survival (RFS) were analyzed by univariate and multivariate analyses. RESULTS Of the 83 patients, 35 (42.2%) had preoperative fasting hyperglycemia. The median OS of the enrolled patients was 12 months. The median OS in patients with fasting hyperglycemia before surgery was 18 months, which was shorter than for patients with normal fasting blood glucose levels before surgery (47 months, P<0.001). Preoperative fasting hyperglycemia was associated with shorter survival times in univariate analyses (HR, 3.215; 95% CI, 1.846-5.601; P<0.001). Multivariate analysis showed that patients with preoperative fasting hyperglycemia had a lower OS (HR, 2.832; 95% CI, 1.480-5.418; P=0.002) and RFS (HR, 2.051; 95% CI, 1.127-3.733; P=0.019) than patients with normal preoperative fasting blood glucose levels. CONCLUSION Preoperative fasting hyperglycemia is an independent indicator of poor prognosis in GBC patients after GBC radical surgery.
Collapse
Affiliation(s)
- Peng Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xiaoqian Wang
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China,
| | - Zhong Hong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Feixia Shen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China,
| | - Qiyu Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China,
| |
Collapse
|
9
|
Banxia Xiexin Decoction () Combined with Afatinib in Treatment of Advanced Gallbladder Cancer: Case Report and Literature Review. Chin J Integr Med 2019; 25:303-306. [PMID: 30707412 DOI: 10.1007/s11655-019-3152-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 01/02/2023]
|
10
|
Bai Y, Liu ZS, Xiong JP, Xu WY, Lin JZ, Long JY, Miao F, Huang HC, Wan XS, Zhao HT. Nomogram to predict overall survival after gallbladder cancer resection in China. World J Gastroenterol 2018; 24:5167-5178. [PMID: 30568393 PMCID: PMC6288645 DOI: 10.3748/wjg.v24.i45.5167] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/23/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To integrate clinically significant variables related to prognosis after curative resection for gallbladder carcinoma (GBC) into a predictive nomogram.
METHODS One hundred and forty-two GBC patients who underwent curative intent surgical resection at Peking Union Medical College Hospital (PUMCH) were included. This retrospective case study was conducted at PUMCH of the Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC) in China from January 1, 2003 to January 1, 2018. The continuous variable carbohydrate antigen 19-9 (CA19-9) was converted into a categorical variable (cCA19-9) based on the normal reference range. Stages 0 to IIIA were merged into one category, while the remaining stages were grouped into another category. Pathological grade X (GX) was treated as a missing value. A multivariate Cox proportional hazards model was used to select variables to construct a nomogram. Discrimination and calibration of the nomogram were performed via the concordance index (C-index) and calibration plots. The performance of the nomogram was estimated using the calibration curve. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were performed to evaluate the predictive accuracy and net benefit of the nomogram, respectively.
RESULTS Of these 142 GBC patients, 55 (38.7%) were male, and the median and mean age were 64 and 63.9 years, respectively. Forty-eight (33.8%) patients in this cohort were censored in the survival analysis. The median survival time was 20 months. A series of methods, including the likelihood ratio test and Akaike information criterion (AIC) as well as stepwise, forward, and backward analyses, were used to select the model, and all yielded identical results. Jaundice [hazard ratio (HR) = 2.9; 95% confidence interval (CI): 1.60-5.27], cCA19-9 (HR = 3.2; 95%CI: 1.91-5.39), stage (HR = 1.89; 95%CI: 1.16-3.09), and resection (R) (HR = 2.82; 95%CI: 1.54-5.16) were selected as significant predictors and combined into a survival time predictive nomogram (C-index = 0.803; 95%CI: 0.766-0.839). High prediction accuracy (adjusted C-index = 0.797) was further verified via bootstrap validation. The calibration plot demonstrated good performance of the nomogram. ROC curve analysis revealed a high sensitivity and specificity. A high net benefit was proven by DCA.
CONCLUSION A nomogram has been constructed to predict the overall survival of GBC patients who underwent radical surgery from a clinical database of GBC at PUMCH.
Collapse
Affiliation(s)
- Yi Bai
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhi-Song Liu
- Department of Statistics, Tianjin University of Finance and Economics Pearl River College, Tianjin 301811, China
| | - Jian-Ping Xiong
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei-Yu Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian-Zhen Lin
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Yu Long
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Fei Miao
- Department of Statistics, Tianjin University of Finance and Economics Pearl River College, Tianjin 301811, China
| | - Han-Chun Huang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xue-Shuai Wan
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hai-Tao Zhao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| |
Collapse
|
11
|
Aldossary MY, Alayed AA, Amr S, Alqahtani MS. Primary squamous cell carcinoma of the gallbladder: Report of a rare neoplasm from the Eastern Province of Saudi Arabia. Int J Surg Case Rep 2018; 51:186-189. [PMID: 30176555 PMCID: PMC6120602 DOI: 10.1016/j.ijscr.2018.08.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 08/14/2018] [Accepted: 08/25/2018] [Indexed: 02/07/2023] Open
Abstract
There is paucity in the literature regarding gallbladder cancer in Saudi Arabia. Only 3% of gallbladder cancers worldwide are primary squamous cell carcinoma (SCC). We present the first case of primary gallbladder SCC reported in Saudi Arabia. Physicians should be aware of this cancer even if it is rare in our country. We should consider gallbladder cancer when diagnosing gallbladder-related symptoms.
Introduction Primary squamous cell carcinoma of the gallbladder is extremely rare, and accounts for about 3% of all malignant gallbladder neoplasms. Presentation of case We report the case of a 58-year-old woman who presented with acute onset epigastric pain radiating to the back. The initial diagnosis, based on radiological images, was an incidental gallbladder mass with multiple gallstones. A staging laparoscopy was performed, followed by exploratory laparotomy with radical cholecystectomy. Segments 4b and 5 of the liver and the first part of the duodenum with the transverse colon were also resected. Histopathology of the gallbladder mass revealed invasive moderately differentiated squamous cell carcinoma with infiltration of liver segments 4b and 5, the first part of the duodenum, and two pericaval lymph nodes (with lymphovascular and perineural invasion). The primary tumour was scored as pT3, pN2, M1, stage IVB, based on the American Joint Committee on Cancer classification, version 7. The patient was discharged postoperatively and started adjuvant chemotherapy. Discussion The best option for treating early-stage gallbladder cancer is radical surgery, while adjuvant chemo-radiation can also be beneficial. Our patient did not exhibit the typical symptoms of gallbladder cancer, and radiography was required for her diagnosis. Thus, additional work is needed to improve the detection of squamous cell carcinoma to improve the prognosis of patients like our own. Conclusion Clinicians must be alert to the possibility of squamous cell gallbladder carcinoma, and gallbladder neoplasms should be among the possibilities considered during the differential diagnosis of symptoms related to the gallbladder.
Collapse
Affiliation(s)
- Mohammed Y Aldossary
- Department of General Surgery, Hepatobiliary Unit, King Fahad Specialist Hospital Dammam, Saudi Arabia.
| | - Amal A Alayed
- Department of General Surgery, Hepatobiliary Unit, King Fahad Specialist Hospital Dammam, Saudi Arabia
| | - Samir Amr
- Department of Pathology and Laboratory Medicine, King Fahad Specialist Hospital-Dammam, Saudi Arabia
| | - Mohammed S Alqahtani
- Department of General Surgery, Hepatobiliary Unit, King Fahad Specialist Hospital Dammam, Saudi Arabia
| |
Collapse
|
12
|
Shukla SK, Singh G, Shahi KS, Bhuvan, Pant P. Staging, Treatment, and Future Approaches of Gallbladder Carcinoma. J Gastrointest Cancer 2018; 49:9-15. [PMID: 29234972 DOI: 10.1007/s12029-017-0036-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Gallbladder cancer is the most common malignant cancer of the bile ducts and third most common gastrointestinal malignant in the world for public health. Its relatively low incidence and confused symptoms result in advanced disease at the time of presentation, contributing to poor prognosis and reduced survival associated with this disease. The main function of the gallbladder is to store excreted bile acids from the liver in preparation for a meal. Its main risk factor is prolonged exposure to biliary calculations, although bacterial infections and other inflammatory conditions are associated. Chronic inflammatory bowel conditions are associated with gallbladder cancer. T stage translates to identifying residual disease at reoperation for incidental gallbladder cancer and residual disease negatively affects survival. CONCLUSION It is the most common cancer of gallbladder, gallbladder cancer remains a rare disease. Gallbladder cancer is a rare disease that can be accidentally diagnosed after cholecystectomy or accidentally, often with more advanced disease. The prognosis is generally extremely poor and improvements in surgical resection of this approach have to be re-evaluated, while the role of chemotherapy and radiotherapy remains controversial.
Collapse
Affiliation(s)
- Sanjeev Kumar Shukla
- Multidisciplinary Research Unit, Government Medical College, Haldwani, Nainital, U.K., India
| | - Govind Singh
- Department of Biochemistry, Government Medical College, Haldwani, Nainital, Uttarakhand (U.K.), 263139, India.
| | - K S Shahi
- Department of Surgery, Government Medical College, Haldwani, Nainital, U.K., India
| | - Bhuvan
- Department of Surgery, Government Medical College, Haldwani, Nainital, U.K., India
| | - Prabhat Pant
- Department of Pathology, Government Medical College, Haldwani, Nainital, U.K., India
| |
Collapse
|
13
|
Wang L, Dong P, Zhang Y, Yang M, Chen Y, Tian BL. Prognostic validation of the updated 8th edition Tumor-Node-Metastasis classification by the Union for International Cancer Control: Survival analyses of 307 patients with surgically treated gallbladder carcinoma. Oncol Lett 2018; 16:4427-4433. [PMID: 30214577 PMCID: PMC6126185 DOI: 10.3892/ol.2018.9189] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 04/17/2018] [Indexed: 02/05/2023] Open
Abstract
In December 2016, the Union for International Cancer Control (UICC) published the 8th edition of the Tumor-Node-Metastasis (TNM) classification of malignant tumors, including a number of vital changes in the definitions of the T2 category, the N category and the stages of gallbladder cancer (GBC). The clinical value of this newly updated classification in patients with surgically treated GBC has not been rigorously validated. The present study aimed to analyze the prognosis of patients with GBC in a high-volume surgical unit, and to validate the prognostic value of the new UICC TNM classification, particularly the main changes in the stages of GBC. Data from 307 patients who were surgically treated and histopathologically diagnosed with GBC between January 2011 and July 2016 in The West China Hospital (Chengdu, Sichuan, China) were retrospectively collected and analyzed. The new UICC criteria distributed 32, 60, 99 and 116 eligible patients in stages I, II, III and IV, respectively. The differences in overall survival time between each stage (I–IV) demonstrated statistical significance (P<0.05). As a result of the main change of this classification, the novel definitions of T2a and T2b effectively stratified the prognosis of patients with T2 GBC (P<0.001). Furthermore, patients with stage IIa tumors also obtained significantly improved overall survival time compared with patients with stage IIb tumors (P=0.04), whereas the comparison between patients with stage IIb and IIIa tumors did not present any notable difference (P=0.20). Additionally, the new N category stratified the survival of the patients effectively (P<0.001). Together with curative resection, this latest classification was indicated to be an independent predictor of survival via multivariate analysis (hazard ratio, 6.25; 95% confidence interval, 3.81–10.26; P<0.001). In conclusion, the newly updated UICC TNM classification could effectively reflect the clinical outcome of patients with surgically treated GBC. Furthermore, tumor location could predict the survival of surgically treated T2 GBC. The novel classification of the N category by the number of lymph nodes involved was also demonstrated to be valid.
Collapse
Affiliation(s)
- Li Wang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ping Dong
- Department of Nuclear Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yi Zhang
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Min Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yang Chen
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Bo-Le Tian
- Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| |
Collapse
|