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. 2016 Nov 15;11(11):e0166361.
doi: 10.1371/journal.pone.0166361. eCollection 2016.

Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

Chen Chen  1 , Zhimin Geng  1 , Haoxin Shen  1 , Huwei Song  1 , Yaling Zhao  2 , Guanjun Zhang  3 , Wenzhi Li  1 , Li Ma  1 , Lin Wang  1
Affiliations

Long-Term Outcomes and Prognostic Factors in Advanced Gallbladder Cancer: Focus on the Advanced T Stage

Chen Chen et al. PLoS One. .

Abstract

Background: Radical resection is an effective therapeutic method to increase the survival rate of patients with gallbladder cancer (GBC). In addition to the surgical approach, the relationships between various clinicopathologic factors and the outcome of patients with GBC remain controversial.

Methods: Clinical and laboratory examination characteristics, pathological and surgical data, and post-operative survival time of 338 patients with advanced GBC who received treatment at the First Affiliated Hospital of Xi'an Jiaotong University, China from January 2008 to December 2012 were analyzed retrospectively. Factors influencing the prognosis of GBC after surgery were analyzed by univariate and multivariate analysis.

Results: The overall survival rates for curative resection patients were significantly greater than those for non-curative resection patients (1-,3-,5-year survival rate and mean-survival time: 59.0%, 47.3%, 44.3% and 22.0 months vs. 12.7%, 8.3%, 7.7% and 3.0 months) (P < 0.001). For the curative resection patients, positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites were all independent risk factors for poor prognosis. For patients with T3 stage, neither segmentectomy of IVb and V nor common bile duct resection improved the prognosis (P = 0.867 and P = 0.948). For patients with T4 stage, aggressive curative resection improved the prognosis (P = 0.007).

Conclusions: An advanced T stage does not preclude curative resection. Positive margin, lymph node metastasis, poorly pathological differentiation and the presence of ascites are all independent risk factors for poor prognosis in the curative intent resection patients. The range of liver resection and whether common bile duct resection is performed do not influence the prognosis as long as R0 resection is achieved.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Overall survival curve of GBC patients.
(A): General overall survival curve; (B): Overall survival curve of R0 and R1/2 resected patients: P< 0.001.
Fig 2
Fig 2. Overall survival curve of T3 GBC patients with different surgical techniques.
(A): Wedge resection vs. segmentectomy IVb/V: P = 0.374. (B): CBD resection VS non-CBD resection: P = 0.305.
See this image and copyright information in PMC

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