1
|
Matsui S, Tanioka T, Nakajima K, Saito T, Kato S, Tomii C, Hasegawa F, Muramatsu S, Kaito A, Ito K. Surgical and Oncological Outcomes of Wedge Resection Versus Segment 4b + 5 Resection for T2 and T3 Gallbladder Cancer: a Meta-Analysis. J Gastrointest Surg 2023; 27:1954-1962. [PMID: 37221386 DOI: 10.1007/s11605-023-05698-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 04/15/2023] [Indexed: 05/25/2023]
Abstract
BACKGROUND Liver resection is the standard operative procedure for patients with T2 and T3 gallbladder cancers (GBC). However, the optimal extent of hepatectomy remains unclear. METHODS We conducted a systematic literature search and meta-analysis to assess the safety and long-term outcomes of wedge resection (WR) vs. segment 4b + 5 resection (SR) in patients with T2 and T3 GBC. We reviewed surgical outcomes (i.e., postoperative complications and bile leak) and oncological outcomes (i.e., liver metastasis, disease-free survival (DFS), and overall survival (OS)). RESULTS The initial search yielded 1178 records. Seven studies reported assessments of the above-mentioned outcomes in 1795 patients. WR had significantly fewer postoperative complications than SR, with an odds ratio of 0.40 (95% confidence interval, 0.26 - 0.60; p < 0.001), although there were no significant differences in bile leak between WR and SR. There were no significant differences in oncological outcomes such as liver metastases, 5-year DFS, and OS. CONCLUSIONS For patients with both T2 and T3 GBC, WR was superior to SR in terms of surgical outcome and comparable to SR in terms of oncological outcomes. WR that achieves margin-negative resection may be a suitable procedure for patients with both T2 and T3 GBC.
Collapse
Affiliation(s)
- Satoshi Matsui
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan.
| | - Toshiro Tanioka
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Kei Nakajima
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Toshifumi Saito
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Syunichiro Kato
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Chiharu Tomii
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Fumi Hasegawa
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Syunsuke Muramatsu
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Akio Kaito
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| | - Koji Ito
- Department of Digestive Surgery, Tsuchiura Kyodo General Hospital, 4-1-1 Otuno, Tsuchiura-shi, Ibaraki, Japan
| |
Collapse
|
2
|
Kunte A, Patkar S, Chaudhari V, Goel M. Role of Peri-operative Chemotherapy in Stage II (pT2N0) Gallbladder Cancers. J Gastrointest Surg 2023; 27:78-88. [PMID: 36279092 DOI: 10.1007/s11605-022-05495-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 10/15/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Evidence for adjuvant chemotherapy in gallbladder cancer (GBC) is conflicting, with a postulated beneficial effect reported in T2 stage or higher, and node-positive tumours. This study aims to assess the survival benefit of peri-operative chemotherapy in stage II (pT2N0) GBCs. METHODS A retrospective analysis of stage II GBCs who underwent curative surgical resection was done. Patients receiving neo-adjuvant therapy (NACT) prior to resection of the gallbladder primary were excluded. Primary endpoint was disease-free survival, and outcomes of patients who received chemotherapy were compared to those who did not. Survival curves were plotted using a Kaplan-Meier analysis and difference between the survival curves was analysed using a log-rank test. RESULTS Two hundred seventy-six patients of stage II GBC were included, of whom 188 (68.1%) received chemotherapy and 88 (31.8%) did not. Forty-one (21.8%) patients received chemotherapy in the neo-adjuvant setting. There was no significant difference in the survival of patients who did and did not receive chemotherapy (5-year DFS 67.8% vs 66%, p = 0.795). There was no significant difference in the survival of patients who received chemotherapy in the adjuvant or neo-adjuvant setting (5-year DFS 66.4% vs 71.8%, p = 0.541). There was no statistically significant difference in the survival of patients with high-risk histologic features and who did and did not receive chemotherapy (3-year DFS 72.4% vs 56%; p = 0.379). CONCLUSIONS Routine use of chemotherapy, either in the adjuvant or neo-adjuvant setting, offers no survival advantage in stage II (pT2N0) gallbladder cancers.
Collapse
Affiliation(s)
- Aditya Kunte
- GI & HPB Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, 1213, Homi Bhabha Block, Dr. Ernest Borges Road, Parel East, Mumbai, 400012, India
| | - Shraddha Patkar
- GI & HPB Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, 1213, Homi Bhabha Block, Dr. Ernest Borges Road, Parel East, Mumbai, 400012, India
| | - Vikram Chaudhari
- GI & HPB Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, 1213, Homi Bhabha Block, Dr. Ernest Borges Road, Parel East, Mumbai, 400012, India
| | - Mahesh Goel
- GI & HPB Services, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, 1213, Homi Bhabha Block, Dr. Ernest Borges Road, Parel East, Mumbai, 400012, India.
| |
Collapse
|
3
|
A Novel Prognostic Nomogram for Gallbladder Cancer after Surgical Resection: A Single-Center Experience. JOURNAL OF ONCOLOGY 2021; 2021:6619149. [PMID: 34447433 PMCID: PMC8383717 DOI: 10.1155/2021/6619149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 12/16/2022]
Abstract
Background Gallbladder cancer (GBC), which accounts for more than 80% of biliary tract malignancies, has a poor prognosis with an overall 5-year survival less than 10%. The study aimed to identify risk factors and develop a predictive model for GBC following surgical resection. Methods 98 GBC patients who underwent surgical resection from Guangdong Provincial People's Hospital were enrolled in the study. Cox-regression analysis was performed to identify significant prognostic factors. A nomogram was constructed and Harrell's concordance index, calibration plot, and decision cure analysis were used to evaluate the discrimination and calibration of the nomogram. Results Liver resection, tumor size, perineural invasion, surgical margin, and liver invasion were identified as independent risk factors for overall survival (OS) in GBC patients who underwent surgical resection. Based on the selected risk factors, a novel nomogram was constructed. The C-index of the nomogram was 0.777, which was higher than the American Joint Committee on Cancer (AJCC) staging system (0.724) and Nevin staging system (0.659). Decision cure analysis revealed that the nomogram had a better net benefit and the calibration curves for the 1-, 3-, and 5-year survival probabilities were also well matched with the actual survival rates. Lastly, high-risk GBC were stratified based on the scores of the nomogram and we found high-risk GBC were associated with both worse OS and disease-free survival (DFS). Conclusion We developed a nomogram showing a better predictive capacity for patients' survival of resected GBC than the AJCC staging systems. The established model may help to stratify high-risk GBC and facilitate decision-making in the clinic.
Collapse
|
4
|
Srivastava V, Verma K, Puneet. Surgical Management of Gallbladder Carcinoma. Indian J Surg 2021. [DOI: 10.1007/s12262-019-02050-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
|
5
|
Chen M, Cao J, Xiang Y, Ma X, Bai Y, Lai Q, Tong C, Ma Z, Topatana W, Hu J, Li S, Juengpanich S, Yu H, Cai X. Hepatectomy strategy for T2 gallbladder cancer between segment IVb and V resection and wedge resection: A propensity score-matched study. Surgery 2021; 169:1304-1311. [PMID: 33551070 DOI: 10.1016/j.surg.2020.12.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 12/30/2020] [Accepted: 12/31/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Liver resection is recommended for T2 gallbladder cancer, but the optimal hepatectomy strategy remains controversial. We aimed to assess the safety and effectiveness of segment IVb and V resection versus wedge resection in patients with T2 gallbladder cancer. METHODS This is a retrospective multicenter propensity score-matched study in China. Overall survival, disease-free survival, perioperative complications, and hospital length of stay were used to evaluate safety and effectiveness. RESULTS There are a total of 512 patients. 112 of 117 patients undergoing segment IVb and V resection were matched to 112 patients undergoing wedge resection. After matching, segment IVb and V resection demonstrated no statistical difference in overall survival (hazard ratio, 0.970 [0.639-1.474]; P = .886), but significance in disease-free survival (hazard ratio, 0.708 [0.506-0.991]; P = .040). Patients with incidental gallbladder cancer (hazard ratio, 0.390 [0.180-0.846]; P = .019), stage T2b (hazard ratio, 0.515 [0.302-0.878]; P = .016), and negative lymph nodes status (hazard ratio, 0.627 [0.406-0.991]; P = .043) were associated with improved disease-free survival after segment IVb and V resection, but not in wedge resection. However, perioperative complications occurred more frequently after segment IVb and V resection (28.5% vs 9.1%, P < .001) along with the longer hospital length of stay (17.3 vs 10.2 days, P < .001). Notably, patients with jaundice (odds ratio, 4.053 [1.361-12.23]; P = .013), undergoing laparoscopic resection (odds ratio, 2.387 [1.059-4.484]; P = .028) or surgeon performing per the first 10 segment IVb and V resections (odds ratio, 2.697 [1.035-6.998]; P = .041), were the independent risk factors for perioperative complications in the segment IVb and V resection group. CONCLUSION T2 gallbladder cancer patients undergoing segment IVb and V resection rather than wedge resection have an improved disease-free survival, especially for incidental gallbladder cancer or hepatic-sided (T2b) gallbladder cancer. However, high rates of perioperative complications and longer hospital length of stay after segment IVb and V resection indicated that surgeons must rely on their own surgical skills and the patient profile to decide the optimal hepatectomy strategy.
Collapse
Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, Zhejiang Province, China; Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China. https://twitter.com/MingyuChen6
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Yukai Xiang
- Department of General Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Xiaochen Ma
- Department of Hepatobiliary Cancer, Liver Cancer Research Center, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin, China
| | - Yang Bai
- Department of General Surgery, Jinhua Center Hospital of Zhejiang University, Jinhua, Zhejiang Province, China; Department of General Surgery, The Second Affiliated Hospital of Zhejiang Medical University, Hangzhou, Zhejiang Province, China
| | - Qihong Lai
- Department of General Surgery, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Chenhao Tong
- Department of General Surgery, Shaoxing People's Hospital of Zhejiang University, Shaoxing, Zhejiang Province, China
| | - Zuyi Ma
- Department of General Surgery, Guangdong Academy of Medical Sciences & Guangdong Provincial People's Hospital, Guangdong Province, China; Shantou University of Medical College, Shantou, China
| | - Win Topatana
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Jiahao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Shijie Li
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Sarun Juengpanich
- Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Hong Yu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, Zhejiang Province, China; Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
| |
Collapse
|
6
|
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: 1] [Impact Index Per Article: 0.3] [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.
Collapse
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
| |
Collapse
|
7
|
Yu X, Lu W, Ng CW, Xu S, Wu Y, Chen S, Gao Y, Zhang Y, Zhang Q, Xu Y, Liu Y, Li S. Computer-aided assessment of the chemokine receptors CXCR3, CXCR4 and CXCR7 expression in gallbladder carcinoma. J Cell Mol Med 2020; 24:7670-7674. [PMID: 32512633 PMCID: PMC7339221 DOI: 10.1111/jcmm.15219] [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: 02/20/2019] [Revised: 01/30/2020] [Accepted: 03/06/2020] [Indexed: 12/13/2022] Open
Abstract
Gallbladder carcinoma (GBC) is a vicious and invasive disease. The major challenge in the clinical treatment of GBC is the lack of a suitable prognosis method. Chemokine receptors such as CXCR3, CXCR4 and CXCR7 play vital roles in the process of tumour progression and metastasis. Their expression levels and distribution are proven to be indicative of the progression of GBC, but are hard to be decoded by conventional pathological methods, and therefore, not commonly used in the prognosis of GBC. In this study, we developed a computer‐aided image analysis method, which we used to quantitatively measure the expression levels of CXCR3, CXCR4 and CXCR7 in the nuclei and cytoplasm of glandular and interstitial cells from a cohort of 55 GBC patients. We found that CXCR3, CXCR4 and CXCR7 expressions are associated with the clinicopathological variables of GBC. Cytoplasmic CXCR3, nuclear CXCR7 and cytoplasmic CXCR7 were significant predictive factors of histology invasion, whereas cytoplasmic CXCR4 and nuclear CXCR4 were significantly correlated with T and N stage and were associated with the overall survival and disease‐free survival. These results suggest that the quantification and localisation of CXCR3, CXCR4 and CXCR7 expressions in different cell types should be considered using computer‐aided assessment to improve the accuracy of prognosis in GBC.
Collapse
Affiliation(s)
- Xiao Yu
- Department of Pathology and Forensic Medicine, Dalian Medical University, Dalian, China
| | - Wei Lu
- Department of General Surgery, School of Medicine, Xinhua Hospital, Shanghai JiaoTong University, Shanghai, China.,Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Chan Way Ng
- Invitrocue Pte Ltd., Singapore City, Singapore
| | - Shuoyu Xu
- Department of Radiology, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yao Wu
- Invitrocue Pte Ltd., Singapore City, Singapore
| | - Shili Chen
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Yuren Gao
- Department of Urology, the second Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Yijian Zhang
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Qingqing Zhang
- Department of Pathology and Forensic Medicine, Dalian Medical University, Dalian, China
| | - Yuzhen Xu
- Department of Gastrointestinal Surgery, Xu Zhou Center Hospital, Affiliated to Medical College of Southeast University, Jiangsu, China
| | - Yingbin Liu
- Department of General Surgery, School of Medicine, Xinhua Hospital, Shanghai JiaoTong University, Shanghai, China.,Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, Shanghai, China
| | - Sheng Li
- National-Local Engineering Research Center for Drug Research and Development (R&D) of Neurodegenerative Diesases, Department of Biochemistry, Dalian Medical University, Dalian, China
| |
Collapse
|
8
|
Bai DS, Chen P, Qian JJ, Jin SJ, Jiang GQ. Effect of marital status on the survival of patients with gallbladder cancer treated with surgical resection: a population-based study. Oncotarget 2018; 8:26404-26413. [PMID: 28460434 PMCID: PMC5432267 DOI: 10.18632/oncotarget.15476] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 02/07/2017] [Indexed: 02/06/2023] Open
Abstract
Marital status has been reported as an independent prognostic factor for survival in various cancers, but it has been rarely studied in gallbladder cancer treated by surgical resection. We retrospectively studied Surveillance, Epidemiology, and End Results (SEER) population-based data and identified 9,041 cases of gallbladder cancer with surgical treatment between 1988 and 2013. The patients were categorized according to marital status, as "married," "never married," "widowed," or "divorced/separated." Patients in the widowed group had a higher proportion of women within-group comparisons, a higher rate of white race, a greater proportion of older (≥ 60 years) patients, more frequency of adenocarcinoma, a greater number of tumors at well/moderate pathological grading, and more prevalence at the localized SEER stage, all of which were statistically significant (P < 0.001). Marital status was confirmed to be an independent prognostic factor by multivariate analysis (P < 0.001). Married patients had higher 5-year gallbladder cancer cause-specific survival than unmarried patients (P < 0.001); conversely, widowed patients had the lowest gallbladder cancer cause-specific survival compared with all other patients. Conclusions marital status is an important prognostic risk factor for survival in patients with gallbladder cancer treated with surgical resection. Widowed patients have the highest risk of death compared with other groups.
Collapse
Affiliation(s)
- Dou-Sheng Bai
- Department of Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Ping Chen
- Department of Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Jian-Jun Qian
- Department of Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Sheng-Jie Jin
- Department of Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| | - Guo-Qing Jiang
- Department of Department of Hepatobiliary and Pancreatic Surgery, Clinical Medical College of Yangzhou University, Yangzhou, China
| |
Collapse
|
9
|
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]
|
10
|
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.
Collapse
|
11
|
Lu W, Cao Y, Zhang Y, Li S, Gao J, Wang XA, Mu J, Hu YP, Jiang L, Dong P, Gong W, Liu Y. Up-regulation of PKM2 promote malignancy and related to adverse prognostic risk factor in human gallbladder cancer. Sci Rep 2016; 6:26351. [PMID: 27283076 PMCID: PMC4901292 DOI: 10.1038/srep26351] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 04/15/2016] [Indexed: 02/08/2023] Open
Abstract
Recently, pyruvate kinase M2 (PKM2) has been implicated in the progression of certain cancers and might play pivotal roles in the formation of malignancy. However, the role of PKM2 in gallbladder cancer had not been well investigated. This study analyzed associations between PKM2 expression status with various clinical and pathologic parameters in a large cohort of gallbladder cancer (GBC) patients from a long term follow up results. The expression level of pyruvate kinase isotypes in GBC tissues and their adjacent normal gallbladder tissues were estimated by qRT-PCR and Western blot. PKM2 mRNA level were significantly high in gallbladder cancer tissues than in adjacent noncancerous tissues (P < 0.001). High expression of the PKM2 was detected in 55.71% paraffin-embedded GBC tissue. The high PKM2 expression was independently associated with poorer overall survival in patients with GBC (median survival 11.9 vs 30.1 months; hazard ratio 2.79; 95% CI = 1.18 to 6.55; P = 0.02). These findings indicated elevated expression of PKM2 is a prognostic factor for poor GBC clinical outcomes, implied involving of PKM2 in GBC progression.
Collapse
Affiliation(s)
- Wei Lu
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
- Institute of Social Cognitive and Behavioral Sciences, Shanghai JiaoTong University, No. 800 Dongchuan Road, Shanghai 200240, China
| | - Yang Cao
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Yijian Zhang
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Sheng Li
- Department of Biochemistry, Dalian medical University, No. 9 Lvshun South Road, Dalian, Liaoning, 116044, China
| | - Jian Gao
- Center of Clinical Epidemiology and Evidence-based Medicine, Fudan University, No. 138 Yixueyuan Road, Shanghai 200032, China
| | - Xu-An Wang
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Jiasheng Mu
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Yun-Ping Hu
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Lin Jiang
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Ping Dong
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Wei Gong
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| | - Yingbin Liu
- Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai JiaoTong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
- Institute of Biliary Tract Diseases Research, Shanghai JiaoTong University School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China
| |
Collapse
|
12
|
Pandey D, Garg PK, Manjunath NML, Sharma J. Extra-Hepatic Bile Duct Resection: an Insight in the Management of Gallbladder Cancer. J Gastrointest Cancer 2016; 46:291-6. [PMID: 26049726 DOI: 10.1007/s12029-015-9737-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Involvement of extrahepatic bile duct in gallbladder cancer (GBC) is considered a sign of advanced disease; resection of extrahepatic bile duct in GBC has been a contentious issue considering the poor prognosis of the disease. METHODS This retrospective study was done in two tertiary teaching hospitals of North India. The case records of all the GBC patients who underwent radical cholecystectomy with extra-hepatic bile duct resection were reviewed. Details concerning the clinical presentation, preoperative therapy, operative procedure, indication of bile duct resection, postoperative complications and outcome were retrieved from the case records. Kaplan-Meier analysis was done to estimate median disease-free survival and overall survival. RESULTS There were 17 GBC patients who underwent radical cholecystectomy with resection of extrahepatic bile duct. Median age of the patients was 51 years (range 35-62); male to female ratio was 5:12. Six patients were diagnosed after histopathological examination of resected gallbladder specimen following cholecystectomy (incidental gallbladder cancer). All the patients had R'0' resection. The indication for extra-hepatic bile duct resection was direct infiltration of hepatoduodenal ligament in nine, positive cystic duct margin in two, densely adherent pericholedochal lymphnodes in one and associated ampullary growth in one patient. Kaplan-Meier analysis predicted median disease-free survival of 20 months and median overall survival of 26 months. CONCLUSION Extrahepatic bile duct resection to achieve R'0' resection in the management of advanced gallbladder cancer is safe with acceptable postoperative morbidity and has potential to improve survival.
Collapse
Affiliation(s)
- Durgatosh Pandey
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India, 110029,
| | | | | | | |
Collapse
|
13
|
Wang P, Shi Q, Zuo T, He X, Yu J, Wang W. Expression of cluster of differentiation 74 in gallbladder carcinoma and the correlation with epithelial growth factor receptor levels. Oncol Lett 2016; 11:2061-2066. [PMID: 26998122 PMCID: PMC4774522 DOI: 10.3892/ol.2016.4191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 01/22/2016] [Indexed: 01/11/2023] Open
Abstract
Cluster of differentiation 74 (CD74), a transmembrane glycoprotein, has been previously reported to be important in the pathogenesis of several cancers, including hematological malignancies and solid tumors. The present study analyzed the significance of CD74 in gallbladder carcinomas (GBCs) and indicated the correlation of CD74 expression with epithelial growth factor receptor levels. Immunohistochemistry (IHC) was used to examine the expression of CD74 in GBC and normal gallbladder tissues, and western blotting was used to investigate whether CD74 expression varied in well-, moderately- and poorly-differentiated tumors. The correlation between the expression of CD74 and epithelial growth factor receptor levels was studied using the Spearman's rank correlation coefficient. The results of the IHC analysis revealed that CD74 was not expressed in the normal gallbladder tissues, and the mean integrated optical density value of CD74 in the poorly-differentiated tissues was increased compared with that in the well- and moderately-differentiated tissues. The results of the western blotting were consistent with the results of the IHC. The expression of CD74 was positively correlated with epithelial growth factor receptor levels (r=0.607; P<0.05). These results indicate that CD74 may be important in the progression of GBC.
Collapse
Affiliation(s)
- Peng Wang
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Qiao Shi
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Teng Zuo
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Xiaobo He
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Jia Yu
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| | - Weixing Wang
- Department of Hepatobiliary and Laparoscopic Surgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, P.R. China
| |
Collapse
|
14
|
|
15
|
Pais-Costa SR, Farah JFDM, Artigiani-Neto R, Martins SJ, Goldenberg A. Evaluation of P53, E-cadherin, Cox-2, and EGFR protein immunoexpression on prognostic of resected gallbladder carcinoma. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:126-32. [PMID: 25004291 PMCID: PMC4678687 DOI: 10.1590/s0102-67202014000200009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 02/27/2014] [Indexed: 12/23/2022]
Abstract
Background Gallbladder carcinoma presents a dismal prognosis. Choice treatment is surgical
resection that is associated a high levels of both morbidity and mortality. Best
knowledgement of prognostic factors may result a better selection of patients
either for surgical or multimodal treatment. Aim To evaluate tecidual immunoexpression of P53, E-cadherin, Cox-2, and EGFR proteins
and to correlate these findings with resected gallbladder adenocarcinoma
survival. Methods Clinical, laboratorial, surgical, and anatomopathological reports of a series of
gallbladder adenocarcinoma patients were collected by individualized questionary.
Total sample was 42 patients. Median of age was 72 years (35-87). There were seven
men and 35 women. Lesion distribuition in according TNM state was the following:
T1 (n=2), T2 (n=5), T3 (n=31), T4 (n=4). Twenty-three patients underwent radical
resection (R0), while 19 palliative surgery (R1-R2). A block of tissue microarray
with neoplasic tissue of each patient was confected. It was performed evaluation
of P53, E-Caderine, COX-2, and EGFR proteins imunoexpression. These findings were
correlated with overall survival. Results Five-year survival was 28%. The median of global survival was eight months. Only
immunoexpression of EGFR protein was considered independent variable at
multivariated analysis. Conclusion Final prognosis was influenced by over-expression of EGFR protein in tumoral
tissue.
Collapse
|
16
|
Abstract
Among biliary tract cancers, gallbladder cancer (GBC) is a potentially lethal malignancy with abysmal long-term survival. Surgery is central to the management of GBC, and presently, provides the only ray of hope for long-term survival. Radical cholecystectomy, which includes cholecystectomy with a limited hepatic resection, regional lymphadenectomy and adjacent organ resection if required is used to encompass the tumor with negative margins - R'0' resection is the standard surgical treatment for the management of GBC. Absence of randomized controlled trials to address various surgical controversies due to rarity of disease in western world, advanced disease at presentation, high frequency of unresectability/inoperability at surgery, deficient neoadjuvant/adjuvant strategies and nihilistic views of oncologists due to aggressive disease biology has resulted in marked heterogeneity in surgical strategies employed to manage GBC across the surgical centers globally.
Collapse
Affiliation(s)
- Pankaj Kumar Garg
- Department of Surgery, University College of Medical Sciences and Guru Teg Bahadur Hospital, University of Delhi, Dilshad Garden, Delhi 110095, India
| | | | | |
Collapse
|
17
|
ZHU WEI, SUN WEI, ZHANG JINGTAO, LIU ZHONGYAN, LI XINPING, FAN YUEZU. Norcantharidin enhances TIMP-2 anti-vasculogenic mimicry activity for human gallbladder cancers through downregulating MMP-2 and MT1-MMP. Int J Oncol 2014; 46:627-40. [DOI: 10.3892/ijo.2014.2753] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/24/2014] [Indexed: 11/06/2022] Open
|
18
|
Wang H, Sun W, Zhang WZ, Ge CY, Zhang JT, Liu ZY, Fan YZ. Inhibition of tumor vasculogenic mimicry and prolongation of host survival in highly aggressive gallbladder cancers by norcantharidin via blocking the ephrin type a receptor 2/focal adhesion kinase/paxillin signaling pathway. PLoS One 2014; 9:e96982. [PMID: 24811250 PMCID: PMC4014585 DOI: 10.1371/journal.pone.0096982] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 04/14/2014] [Indexed: 01/15/2023] Open
Abstract
Vasculogenic mimicry (VM) is a newly-defined tumor microcirculation pattern in highly aggressive malignant tumors. We recently reported tumor growth and VM formation of gallbladder cancers through the contribution of the ephrin type a receptor 2 (EphA2)/focal adhesion kinase (FAK)/Paxillin signaling pathways. In this study, we further investigated the anti-VM activity of norcantharidin (NCTD) as a VM inhibitor for gallbladder cancers and the underlying mechanisms. In vivo and in vitro experiments to determine the effects of NCTD on tumor growth, host survival, VM formation of GBC-SD nude mouse xenografts, and vasculogenic-like networks, malignant phenotypes i.e., proliferation, apoptosis, invasion and migration of GBC-SD cells. Expression of VM signaling-related markers EphA2, FAK and Paxillin in vivo and in vitro were examined by immunofluorescence, western blotting and real-time polymerase chain reaction (RT-PCR), respectively. The results showed that after treatment with NCTD, GBC-SD cells were unable to form VM structures when injecting into nude mouse, growth of the xenograft was inhibited and these observations were confirmed by facts that VM formation by three-dimensional (3-D) matrix, proliferation, apoptosis, invasion, migration of GBC-SD cells were affected; and survival time of the xenograft mice was prolonged. Furthermore, expression of EphA2, FAK and Paxillin proteins/mRNAs of the xenografts was downregulated. Thus, we concluded that NCTD has potential anti-VM activity against human gallbladder cancers; one of the underlying mechanisms may be via blocking the EphA2/FAK/Paxillin signaling pathway.
Collapse
Affiliation(s)
- Hui Wang
- Department of Surgery, Tongji Hospital, Tongji University School of Medicine, Tongji University, Shanghai, P.R. China
| | - Wei Sun
- Department of Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Tongji University, Shanghai, P.R. China
| | - Wen-Zhong Zhang
- Department of Surgery, Shanghai Pudong New Area People's Hospital, Shanghai, P.R. China
| | - Chun-Yan Ge
- Department of Oncology, Shanghai Yangpu Geriatric Hospital, Shanghai, P.R. China
| | - Jing-Tao Zhang
- Department of Surgery, Tongji Hospital, Tongji University School of Medicine, Tongji University, Shanghai, P.R. China
| | - Zhong-Yan Liu
- Department of Surgery, Tongji Hospital, Tongji University School of Medicine, Tongji University, Shanghai, P.R. China
| | - Yue-Zu Fan
- Department of Surgery, Tongji Hospital, Tongji University School of Medicine, Tongji University, Shanghai, P.R. China
| |
Collapse
|
19
|
Zhang JT, Sun W, Zhang WZ, Ge CY, Liu ZY, Zhao ZM, Lu XS, Fan YZ. Norcantharidin inhibits tumor growth and vasculogenic mimicry of human gallbladder carcinomas by suppression of the PI3-K/MMPs/Ln-5γ2 signaling pathway. BMC Cancer 2014; 14:193. [PMID: 24628713 PMCID: PMC3985599 DOI: 10.1186/1471-2407-14-193] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/10/2014] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Vasculogenic mimicry (VM) is a novel tumor blood supply in some highly aggressive malignant tumors. Recently, we reported VM existed in gallbladder carcinomas (GBCs) and the formation of the special passage through the activation of the PI3K/MMPs/Ln-5γ2 signaling pathway. GBC is a highly aggressive malignant tumor with disappointing treatments and a poor prognosis. Norcantharidin (NCTD) has shown to have multiple antitumor activities against GBCs, etc; however the exact mechanism is not thoroughly elucidated. In this study, we firstly investigated the anti-VM activity of NCTD as a VM inhibitor for GBCs and its underlying mechanisms. METHODS In vitro and in vivo experiments to determine the effects of NCTD on proliferation, invasion, migration, VM formation, hemodynamic and tumor growth of GBC-SD cells and xenografts were respectively done by proliferation, invasion, migration assays, H&E staining and CD31-PAS double stainings, optic/electron microscopy, tumor assay, and dynamic micro-MRA. Further, immunohistochemistry, immunofluorescence, Western blotting and RT-PCR were respectively used to examine expression of VM signaling-related markers PI3-K, MMP-2, MT1-MMP and Ln-5γ2 in GBC-SD cells and xenografts in vitro and in vivo. RESULTS After treatment with NCTD, proliferation, invasion, migration of GBC-SD cells were inhibited; GBC-SD cells and xenografts were unable to form VM-like structures; tumor center-VM region of the xenografts exhibited a decreased signal in intensity; then cell or xenograft growth was inhibited. Whereas all of untreated GBC-SD cells and xenografts formed VM-like structures with the same conditions; the xenograft center-VM region exhibited a gradually increased signal; and facilitated cell or xenograft growth. Furthermore, expression of MMP-2 and MT1-MMP products from sections/supernates of 3-D matrices and the xenografts, and expression of PI3-K, MMP-2, MM1-MMP and Ln-5γ2 proteins/mRNAs of the xenografts were all decreased in NCTD or TIMP-2 group; (all P < 0.01, vs. control group); NCTD down-regulated expression of these VM signaling-related markers in vitro and in vivo. CONCLUSIONS NCTD inhibited tumor growth and VM of human GBCs in vitro and in vivo by suppression of the PI3-K/MMPs/Ln-5γ2 signaling pathway. It is firstly concluded that NCTD may be a potential anti-VM agent for human GBCs.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Yue-Zu Fan
- Department of Surgery, Tongji Hospital, Tongji University School of Medicine, Tongji University, Shanghai 200065, P,R, China.
| |
Collapse
|
20
|
Ferrarese AG, Solej M, Enrico S, Falcone A, Catalano S, Pozzi G, Marola S, Martino V. Diagnosis of incidental gallbladder cancer after laparoscopic cholecystectomy: our experience. BMC Surg 2013; 13 Suppl 2:S20. [PMID: 24268097 PMCID: PMC3850984 DOI: 10.1186/1471-2482-13-s2-s20] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Gallbladder carcinoma is a rare high malignancy neoplasm. The incidence of intra or post-operative incidental gallbladder carcinoma diagnosis is estimated between 0,2 and 2,8%. Primary aim of our study is to evaluate incidental gallbladder carcinoma's incidence in our experience. Methods We retrospectively reviewed our Surgery Division's experience about the totality of laparoscopic cholecystectomies with post-operative histological evidence of incidental gallbladder cancer. We evaluated patients' characteristics, surgical related variables, histological response, surgivcal radicalization characteristics and surgical outcome. Results In the considered sample we observed 7 accidental gallbladder adenocarcinomas in post-operative histological examination. Pathological results were:1 pT1b N0 (G1), 2 pT2 N0 (G2), 2 pT2 N1 (G3b), 2 pT3 N1 (G3b) (Table 1). In 5 cases we performed neoplasm radicalization surgery with standard procedure revision. Two patients died before radicalization. Median global survival was 34 months. Conclusion With the increase of laparoscopic cholecystectomies both elective and urgent performed in our centre we observed also an increase of incidentally diagnosed gallbladder neoplasms. Early diagnosis, meticulous peri-operative study and accurate surgical strategy are essential factors to obtain good results in incidental gallbladder cancer.
Collapse
|
21
|
Lu XS, Sun W, Ge CY, Zhang WZ, Fan YZ. Contribution of the PI3K/MMPs/Ln-5γ2 and EphA2/FAK/Paxillin signaling pathways to tumor growth and vasculogenic mimicry of gallbladder carcinomas. Int J Oncol 2013; 42:2103-15. [PMID: 23588386 DOI: 10.3892/ijo.2013.1897] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 03/26/2013] [Indexed: 12/17/2022] Open
Abstract
Vasculogenic mimicry (VM) is a new tumor blood supply in some highly aggressive malignant tumors. We previously reported VM in human gallbladder carcinomas, 3-D matrices in vitro and nude mouse xenografts in vivo of highly aggressive GBC-SD cells and its clinical significance. In this study, we further studied the underlying mechanisms of VM in gallbladder carcinomas via the 3-D matrix in vitro, the nude mouse xenografts in vivo of GBC-SD or SGC-996 cells, immunohistochemistry (H&E staining and CD31-PAS double staining), electron microscopy, expression of MMP-2, MT1-MMP, PI3K, Ln-5γ2, EphA2, FAK and Paxillin-P proteins/mRNAs determined by SABC, ELISA, immunofluorescence, western blotting and qRT-PCR, respectively. It was shown that all of untreated highly aggressive GBC-SD cells and xenografts formed vasculogenic-like structures within 2 weeks of seeding and injecting, and facilitated the growth of tumor cells or xenografts; whereas poorly aggressive SGC-996 cells or GBC-SD cells treated by TIMP-2 were unable to form the vasculogenic-like structures with the same conditions; and tumor xenograft growth was inhibited. Expression of MMP-2, MT1-MMP proteins/mRNAs from sections and supernates of 3-D matrix in vitro, expression of PI3K, MMP-2, MT1-MMP, Ln-5γ2, EphA2, FAK and Paxillin-P proteins/mRNAs from sections of xenografts in vivo in untreated GBC-SD group was upregulated significantly (all P<0.001); however, expression of these VM signal-related proteins/mRNAs in the SGC-996 group and GBC-SD treated by the TIMP-2 group was significantly downregulated (all P<0.001). Thus, we identified for the first time that highly aggressive GBC-SD cells formed VM in vitro and in vivo through the upregulation of PI3K/MMPs/Ln-5γ2 and/or EphA2/FAK/Paxillin signaling. PI3K/MMPs/Ln-5γ2 and EphA2/FAK/Paxillin as key signaling pathways in a coordinated manner contributed to tumor growth and VM of gallbladder carcinomas and provided novel targets that could be potentially exploited for therapeutic intervention of human gallbladder carcinomas.
Collapse
Affiliation(s)
- Xin-Sui Lu
- Department of Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, P.R. China
| | | | | | | | | |
Collapse
|
22
|
Pais-Costa SR, Farah JFDM, Artigiani-Neto R, Franco MIF, Martins SJ, Goldenberg A. Adenocarcinoma da vesícula biliar: avaliação dos fatores prognósticos em 100 casos ressecados no Brasil. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2012; 25:13-9. [DOI: 10.1590/s0102-67202012000100004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
RACIONAL: A despeito da sua relativa raridade, o adenocarcinoma de vesícula biliar é neoplasia que apresenta comportamento biológico agressivo. O único tratamento curativo tem sido a ressecção cirúrgica radical com margem livre. Fatores prognósticos têm sido estudados por serem importantes para identificar pacientes que podem se beneficiar de ressecção cirúrgica agressiva. OBJETIVO: Avaliar preditores prognósticos em longo prazo de pacientes com câncer da vesícula biliar. MÉTODOS: Foram identificados e retrospectivamente revisados os prontuários médicos de todos os doentes submetidos a tratamento cirúrgico que apresentavam diagnóstico histológico confirmado de adenocarcinoma de vesícula biliar durante período de 14 anos. Os dados foram submetidos à análise estatística uni e multivariada. RESULTADOS: A amostra total foi de 100 doentes. A mediana de idade foi de 71 anos (34 a 93). Houve 17 mulheres e 83 homens. A distribuição das lesões de acordo com o sistema de estadiamento TNM foi: I (n=22), II (n=59), III (n=6), IV (n=4) e desconhecido (n=9). Cinquenta e dois doentes foram submetidos à ressecção radical (R0) enquanto 48 à cirurgia paliativa (R1-R2). A morbidade global foi de 14% enquanto que a mortalidade pós-operatória (até 30º dia do pós-operatório) foi de 12 %. A taxa de sobrevida em cinco anos foi de 28% enquanto a mediana de sobrevida foi de 10 meses. A análise multivariada identificou seis fatores prognósticos: estádio T, nível sérico de CA 19.9, perfuração da vesícula biliar, embolização linfática, coorte cirúrgico histórico e linfadenectomia hilar. CONCLUSÃO: O tratamento do câncer de vesícula biliar apresenta alta morbimortalidade. Os fatores prognósticos foram: estádio T, nível sérico de CA 19.9, perfuração da vesícula biliar, embolização linfática, coorte cirúrgico histórico e linfadenectomia hilar.
Collapse
|
23
|
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.
Collapse
Affiliation(s)
- Samuel J Wang
- Oregon Health & Science University, Portland, 97239-3098, USA.
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Sun W, Fan YZ, Zhang WZ, Ge CY. A pilot histomorphology and hemodynamic of vasculogenic mimicry in gallbladder carcinomas in vivo and in vitro. J Exp Clin Cancer Res 2011; 30:46. [PMID: 21529356 PMCID: PMC3098797 DOI: 10.1186/1756-9966-30-46] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Accepted: 04/29/2011] [Indexed: 11/12/2022] Open
Abstract
Background Vasculogenic mimicry (VM), as a new blood supply for tumor growth and hematogenous metastases, has been recently described in highly aggressive human melanoma cells, etc. We previously reported VM in human gallbladder carcinomas and its clinical significance. In this study, we further studied histomorphology and hemodynamic of VM in gallbladder carcinomas in vivo and in vitro. Methods The invasive potential of human gallbladder carcinoma cell lines GBC-SD and SGC-996 were identified by Transwell membrane. The vasculogenic-like network structures and the signal intensities i.e. hemodynamic in gallbladder carcinomas stimulated via the three-dimensional matrix of GBC-SD or SGC-996 cells in vitro, the nude mouse xenografts of GBC-SD or SGC-996 cells in vivo were observed by immunohistochemistry (H&E staining and CD31-PAS double staining), electron microscopy and micro-MRA with HAS-Gd-DTPA, respectively. Results Highly aggressive GBC-SD or poorly aggressive SGC-996 cells preconditioned by highly aggressive GBC-SD cells could form patterned networks containing hollow matrix channels. 85.7% (6/7) of GBC-SD nude mouse xenografts existed the evidence of VM, 5.7% (17/300) channels contained red blood cells among these tumor cell-lined vasculatures. GBC-SD xenografts showed multiple high-intensity spots similar with the intensity observed at tumor marginal, a result consistent with pathological VM. Conclusions VM existed in gallbladder carcinomas by both three-dimensional matrix of highly aggressive GBC-SD or poorly aggressive SGC-996 cells preconditioned by highly aggressive GBC-SD cells in vitro and GBC-SD nude mouse xenografts in vivo.
Collapse
Affiliation(s)
- Wei Sun
- Department of Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | | | | | | |
Collapse
|