Pilot study of the relationship between clinical classification of gallbladder cancer and prognosis: a retrospective multicenter clinical study

Dong Zhang; Zhimin Geng; Chen Chen; Yongjie Zhang; Yinghe Qiu; Ning Yang; Desheng Wang; Xuezhi Wang; Tianqiang Song; Jianying Lou; Jiangtao LI; Xianhai Mao; Wenbin Duan; Shengping LI; Xiangming Lao; Xiangqian Zhao; Yajin Chen; Lei Zhang; Yudong Qiu; Jiansheng Liu; Yongyi Zeng; Wei Gong; Zhaohui Tang; Qingguang Liu; Zhiwei Quan

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Pilot study of the relationship between clinical classification of gallbladder cancer and prognosis: a retrospective multicenter clinical study

VernacularTitle: 胆囊癌的临床分型和预后关系初步分析：多中心回顾性临床研究
Author: Dong ZHANG ¹ ; Zhimin GENG ¹ ; Chen CHEN ¹ ; Yongjie ZHANG ² ; Yinghe QIU ² ; Ning YANG ² ; Desheng WANG ³ ; Xuezhi WANG ³ ; Tianqiang SONG ⁴ ; Jianying LOU ⁵ ; Jiangtao LI ⁵ ; Xianhai MAO ⁶ ; Wenbin DUAN ⁶ ; Shengping LI ⁷ ; Xiangming LAO ⁷ ; Xiangqian ZHAO ⁸ ; Yajin CHEN ⁹ ; Lei ZHANG ⁹ ; Yudong QIU ¹⁰ ; Jiansheng LIU ¹¹ ; Yongyi ZENG ¹² ; Wei GONG ¹³ ; Zhaohui TANG ¹³ ; Qingguang LIU ¹ ; Zhiwei QUAN ³
Author Information

1. Department of Hepatobiliary Surgery, First Affiliated Hospital, Xi′an Jiaotong University, Xi′an 710061, China
2. Department of Biliary Surgery, Oriental Hepatobiliary Hospital Affiliated to Naval Medical University, Shanghai 200433, China
3. Department of Hepatobiliary Surgery, the First Affiliated Hospital of Air Force Medical University, Xi′an 710032, China
4. Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Hospital, Tianjin 300060, China
5. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
6. Department of Hepatobiliary Surgery, Hunan Provincial People′s Hospital, Changsha 410005, China
7. Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou 510060, China
8. Department of Hepatobiliary Surgery, First Medical Center, Chinese People′s Liberation Army General Hospital, Beijing 100853, China
9. Department of Hepatobiliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
10. Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School, Nanjing 210008, China
11. Department of Hepatobiliary Surgery, the First Hospital of Shanxi Medical University, Taiyuan 030001, China
12. Department of Hepatobiliary Surgery, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China
13. Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
Publication Type:Journal Article
Keywords: Gallbladder neoplasm; Clinical classification; Prognosis; Radical resection
From: Chinese Journal of Surgery 2019;57(4):258-264
CountryChina
Language:Chinese
Abstract: Objectives:To propose a novel clinical classification system of gallbladder cancer, and to investigate the differences of clinicopathological characteristics and prognosis based on patients who underwent radical resection with different types of gallbladder cancer.
Methods:The clinical data of 1 059 patients with gallbladder cancer underwent radical resection in 12 institutions in China from January 2013 to December 2017 were retrospectively collected and analyzed.There were 389 males and 670 females, aged (62.0±10.5)years(range:22-88 years).According to the location of tumor and the mode of invasion,the tumors were divided into peritoneal type, hepatic type, hepatic hilum type and mixed type, the surgical procedures were divided into regional radical resection and extended radical resection.The correlation between different types and T stage, N stage, vascular invasion, neural invasion, median survival time and surgical procedures were analyzed.Rates were compared by χ² test, survival analysis was carried by Kaplan-Meier and Log-rank test.
Results:Regional radical resection was performed in 940 cases,including 81 cases in T1 stage,859 cases in T2-T4 stage,119 cases underwent extended radical resection;R0 resection was achieved in 990 cases(93.5%).The overall median survival time was 28 months.There were 81 patients in Tis-T1 stage and 978 patients in T2-T4 stage.The classification of gallbladder cancer in patients with T2-T4 stage: 345 cases(35.3%)of peritoneal type, 331 cases(33.8%) of hepatic type, 122 cases(12.5%) of hepatic hilum type and 180 cases(18.4%) of mixed type.T stage(χ²=288.60,P<0.01),N stage(χ²=68.10, P<0.01), vascular invasion(χ²=128.70, P<0.01)and neural invasion(χ²=54.30, P<0.01)were significantly correlated with the classification.The median survival time of peritoneal type,hepatic type,hepatic hilum type and mixed type was 48 months,21 months,16 months and 11 months,respectively(χ²=80.60,P<0.01).There was no significant difference in median survival time between regional radical resection and extended radical resection in the peritoneal type,hepatic type,hepatic hilum type and mixed type(all P>0.05).
Conclusion:With application of new clinical classification, different types of gallbladder cancer are proved to be correlated with TNM stage, malignant biological behavior and prognosis, which will facilitate us in preoperative evaluation,surgical planning and prognosis evaluation.