Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer

Objectives: Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve survival in patients with GBC. This study aimed to analyze the prognostic factors in patients with stage Ⅳ GBC and t...

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Autores principales:	Chen Chen, Lin Wang, Rui Zhang, Qi Li, Ya-Ling Zhao, Guan-Jun Zhang, Wen-Zhi Li, Zhi-Min Geng
Formato:	article
Lenguaje:	EN
Publicado:	KeAi Communications Co., Ltd. 2019
Materias:	Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/b394115aad694fe6b33eae4a3006c457
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spelling	oai:doaj.org-article:b394115aad694fe6b33eae4a3006c4572021-12-02T16:02:32ZWho benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer2095-882X10.1016/j.cdtm.2019.08.004https://doaj.org/article/b394115aad694fe6b33eae4a3006c4572019-09-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2095882X19300696https://doaj.org/toc/2095-882XObjectives: Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve survival in patients with GBC. This study aimed to analyze the prognostic factors in patients with stage Ⅳ GBC and to identify a subgroup of patients who might benefit from R0 resection. Methods: A total of 285 patients with stage Ⅳ GBC were retrospectively analyzed at our institution from January 2008 to December 2012. Factors potentially influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analyses. Results: The 1-, 3-, and 5-year overall survival rates were 6.6% (15/229), 0.9% (2/229), and 0 (0/229), respectively. Ascites (relative risk [RR] = 1.631, 95% confidence interval [CI]: 1.221–2.180, P = 0.001), pathological grade (RR = 1.337, 95% CI: 1.050–1.702, P = 0.018), T stage (RR = 1.421, 95% CI: 1.099–1.837, P = 0.000), M stage (RR = 1.896, 95% CI: 1.409–2.552, P = 0.000), and surgery (RR = 1.542, 95% CI: 1.022–2.327, P = 0.039) were identified as independent risk factors influencing prognosis. The median survival time (MST) was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection (6.0 vs. 2.7 months; P < 0.001). In subgroup analyses, stage ⅣA patients benefited from R0 resection (MST for R0 vs. R1/R2, 11.0 vs. 4.0 months; P = 0.003), while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage ⅣB GBC without distant metastasis (MST for R0 vs. R1/R2, 6.0 vs. 3.0 months; P = 0.007). Conclusion: Ascites, pathological grade, T stage, M stage, and surgery were independent risk factors influencing prognosis in patients with stage IV GBC. N2 lymph node metastasis did not preclude curative resection, and radical resection should be considered in patients with stage Ⅳ GBC without distant metastasis once R0 margin was achieved. Keywords: Gallbladder cancer, Surgery, Prognosis, Tumor-node-metastasis (TNM) stageChen ChenLin WangRui ZhangQi LiYa-Ling ZhaoGuan-Jun ZhangWen-Zhi LiZhi-Min GengKeAi Communications Co., Ltd.articleMedicine (General)R5-920ENChronic Diseases and Translational Medicine, Vol 5, Iss 3, Pp 188-196 (2019)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine (General) R5-920
spellingShingle	Medicine (General) R5-920 Chen Chen Lin Wang Rui Zhang Qi Li Ya-Ling Zhao Guan-Jun Zhang Wen-Zhi Li Zhi-Min Geng Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer
description	Objectives: Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve survival in patients with GBC. This study aimed to analyze the prognostic factors in patients with stage Ⅳ GBC and to identify a subgroup of patients who might benefit from R0 resection. Methods: A total of 285 patients with stage Ⅳ GBC were retrospectively analyzed at our institution from January 2008 to December 2012. Factors potentially influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analyses. Results: The 1-, 3-, and 5-year overall survival rates were 6.6% (15/229), 0.9% (2/229), and 0 (0/229), respectively. Ascites (relative risk [RR] = 1.631, 95% confidence interval [CI]: 1.221–2.180, P = 0.001), pathological grade (RR = 1.337, 95% CI: 1.050–1.702, P = 0.018), T stage (RR = 1.421, 95% CI: 1.099–1.837, P = 0.000), M stage (RR = 1.896, 95% CI: 1.409–2.552, P = 0.000), and surgery (RR = 1.542, 95% CI: 1.022–2.327, P = 0.039) were identified as independent risk factors influencing prognosis. The median survival time (MST) was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection (6.0 vs. 2.7 months; P < 0.001). In subgroup analyses, stage ⅣA patients benefited from R0 resection (MST for R0 vs. R1/R2, 11.0 vs. 4.0 months; P = 0.003), while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage ⅣB GBC without distant metastasis (MST for R0 vs. R1/R2, 6.0 vs. 3.0 months; P = 0.007). Conclusion: Ascites, pathological grade, T stage, M stage, and surgery were independent risk factors influencing prognosis in patients with stage IV GBC. N2 lymph node metastasis did not preclude curative resection, and radical resection should be considered in patients with stage Ⅳ GBC without distant metastasis once R0 margin was achieved. Keywords: Gallbladder cancer, Surgery, Prognosis, Tumor-node-metastasis (TNM) stage
format	article
author	Chen Chen Lin Wang Rui Zhang Qi Li Ya-Ling Zhao Guan-Jun Zhang Wen-Zhi Li Zhi-Min Geng
author_facet	Chen Chen Lin Wang Rui Zhang Qi Li Ya-Ling Zhao Guan-Jun Zhang Wen-Zhi Li Zhi-Min Geng
author_sort	Chen Chen
title	Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer
title_short	Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer
title_full	Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer
title_fullStr	Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer
title_full_unstemmed	Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer
title_sort	who benefits from r0 resection? a single-center analysis of patients with stage ⅳ gallbladder cancer
publisher	KeAi Communications Co., Ltd.
publishDate	2019
url	https://doaj.org/article/b394115aad694fe6b33eae4a3006c457
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Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer

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