Abstract: Objective:To analyze the clinical characteristics of gallbladder carcinoma (GBC), summarize surgical experiences and investigate prognostic factors.
Methods The retrospective crosssectional study was adopted. The clinical data of 438 patients with GBC who underwent surgery at First Affiliated Hospital of Xi′an Jiaotong University from January 2008 to December 2012 were collected. The surgical plan was determined according to the preoperative stage by imaging and laboratory examinations. The clinical characteristics, results of imaging examination and laboratory examination, surgical result, results of pathological examination, followup and survival situations were analyzed. There were univariate and multivariate analyses on the demographic characteristics (gender, age and blood type), underlying diseases (hypertension and diabetes mellitus), clinical pathological characteristics (preoperative jaundice, gallstone history, peritoneal effusion, surgical method, unsuspected gallbladder carcinoma, volume of intraoperative blood loss, tumor location, tumor morphology, pathological type, tumor differentiation, TNM stage, liver infiltration, primary lesion, lymph node metastasis and distant metastasis). The followup by outpatient examination and telephone interview was performed to detect the survival of patients up to October 2014 with death as end point. Count data were reprensted as percentage. The survival curve was drawn by the KaplanMeier method. The univariate analysis and multivariate analysis of prognosis were respectively done using the Logrank test and COX regression model.
Results:(1) Clinical characteristics: of 438 patients, pain in the right hypochondriac region was detected in 328 patients, anorexia in 178 patients, body weight loss in 135 patients, jaundice in 114 patients, nausea and vomiting in 65 patients, abdominal distension in 39 patients, malaise in 37 patients, mass in the epigastric region in 25 patients, fever in 21 patients and no symptom in 40 patients. Among all the patients, 259 were combined with gallstones, 7 with choledocholithiasis, 81 with hypertension, 34 with diabetes mellitus and 13 with viral hepatitis. (2) Results of imaging and laboratory examinations: diagnostic rates of ultrasound, computed tomography (CT) and magnetic resonance imaging (MRI) were 78.47%(277/353), 78.50%(252/321) and 59.68%(74/124), respectively. The increased levels of CA19-9, CA125 and CEA were 58.17%(146/251), 48.90%(111/227) and 35.04%(96/274), respectively. (3) Results of surgery: all the patients underwent surgery, including 165 undergoing R0 resection, 19 undergoing R1 resection and 254 undergoing R2 resection. Ninetythree patients were complicated with intraoperative peritoneal effusion and 67 with unsuspected gallbladder carcinomas. Five patients were dead during the perioperative period, including 1 of pulmonary embolism, 1 of pulmonary infection, 1 of intestinal fistula and 2 of multiple organ failures. (4) Results of pathological examination: Of 438 patients, 257 patients were found tumor location, tumors in the bottom of gallbladder were detected in 92 patients, tumors in the body of gallbladder in 70 patients, tumors in the neck of gallbladder in 48 patients，tumors in the bottom and body of gallbladder in 33 patients, tumors in the neck and body of gallbladder in 13 patients and tumors of cystic duct in 1 patient. There were 68.75%(187/272) invasive tumors and 31.25%(85/272) protruded tumors. There were 372 patients with adenocarcinomas, 24 with adenosquamous carcinomas, 14 with mucinous adenocarcinomas, 10 with squamous cell carcinomas, 10 with small cell carcinomas and 8 with sarcomatoid carcinomas or carcinosarcomas. High, moderate and low differentiated tumors were respectively confirmed in 37, 189 and 206 patients. There was no pathological stage in 6 patients with sarcomatoid carcinomas. Three, 10, 5, 81, 54, 69 and 216 were detected in stage 0, Ⅰ, Ⅱ, ⅢA, ⅢB, ⅣA and ⅣB，respectively. Of 438 patients, 245 were associated with liver infiltration, 331 with lymph node metastases and 122 with distal metastases. (5) Of 438 patients, 366 were followed up for a median time of 21.0 months (range, 1.0-81.0 months), with a median survival time of 5.7 months and average survival time of 24.6 months. The 1, 3, 5year survival rates were 34.2%, 26.8% and 25.4%, respectively. (6) The results of univariate analysis showed that preoperative jaundice, peritoneal effusion, surgical method, unsuspected gallbladder carcinoma, tumor morphology, pathological type and differentiation, TNM stage, liver infiltration, T stage, N stage and M stage were risk factors affecting the prognosis of patients (χ²=7.732, 80.008, 117.556, 25.537, 9.787, 5.417, 43.749, 246.781, 99.227, 111.950, 197.086, 154.731, P<0.05). There was a statistically significant difference in 5year survival rate of patients in the different TNM stage (P<0.05), and 5year survival rate of patients undergoing R0 resection was significantly higher than that undergoing R1 or R2 resections (P<0.05). (7) The results of multivariate analysis showed that peritoneal effusion, moderate and low differentiated tumors, N1-N2 stage, M1 stage and R1 or R2 resections were independent risk factors affecting the prognosis of patients (OR=1.864, 2.022, 1.385, 1.748, 1.895; 95% confidence interval: 1.208-2.878, 1.325-3.085, 1.037-1.851, 1.370-2.230, 1.259-2.853).
ConclusionRadical resection of GBC could improve the prognosis of patients, and peritoneal effusion, moderate and low differentiated tumors, N1-N2 stage, M1 stage and R1 or R2 resections are independent risk factors affecting the prognosis of patients after surgery.