ABSTRACT
0.05).However,the percentage of patients with cholecystolithiassis was 86.5% in IGC group,and 50.6% in GC group(P=0.000).Besides the percentage of IA stage in IGC group(29.7%) was relatively higher than that(9.0%)in GC group(P=0.03);the surgical resection rate of tumor in IGC group was 56.8% and 32.6% in GC group(P=0.01).Nevertheless,the percentage of advance stage in IGC group(43.2%) was relatively lower than that in GC group(74.2%)(P=0.001).The overall 1,3,and 5-year survival rate of IGC group was 70.0%,31.2% and 26.8% repectively,and the mean survival time was17 months(51?13);which were significantly higher than those in GC group,in which the 1,3,5-year survival rate was 27.0%,17.7% and 15.1% repectively and the mean survival time was(25?8),5 months(all P=0.006).Single factor analysis showed that the survival time in IGC patients was influenced by the TNM stage(P=0.000),pT-category(P=0.000),operation-category(P=0.008);however,postoperative pathological grade(P=0.080),age(P=0.188) and sex(P=0.234) had no influence on survival rate.According to multivariate analysis,pT-category(P=0.000)was an independent factor for the survival time of IGC.Conclusions Comparing with GC group,IGC has a higher percentage of cholecystolithiassis,IA tumor stage and surgical resection rate,and thus,it has relatively better progonosis.pT-category is the vital independent prognostic factor in IGC.If a patient in ICG has been misdiagnosed during the primary operation,the patient should be re-operated for radical excision as soon as possible,except when the tumor is in stage Tis or T1a.
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Objective To analyze the causes of preoperative misdiagnosis of primary gallbladder carcinoma,and the effective measures of prevention of the misdiagnosis.Methods We retrospectively analyzed the clinicalrecords of 52 cases with primary gallbladder carcinoma that had been treated in our hospital in 10 years,and analyzed the causes of misdiagnosis.Results Nineteen cases were diagnosed preoperatively(36.5%),while 33 cases were misdiagnosed before operation(63.5%),including misdiagnsed as cholecystolithiasisin 13 cases,gallbladder polyps in 8cases,atrophic cholecystitis in 4cases,hepatic hilar cholangiocarcinoma in 3 cases,tumor of liver in 4 cases,and Mirizzi syndrome in 1 case.There were 29 casesdiagnosed during operation(55.8%),and 4 cases misdiagnosed intratoperatively(7.7%).Misdiagnosiswas due to several reasons:complicated with other gallbladder disease,lack of distinctive clinical features of gallbladder carcinoma,over dependence on imaging methods,and not doing fast frozen section duringoperation in dubious cases.Conclusions In suspected cases with high risk of gallbladder cancer,imagingstudies should be performed,and,if necessary,invasive studies and even exploratory laparotomy should be done.Also,intraoperative rapid frozen section can result in early discovery and treatment,and is conducive to improvement of prognosis of gallbladder carcinoma.
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Objective To estimative the relationship between ras gene mutation,PCNA overexpression and the recurrence and prognosis of gallbladder cancer.Methods PCNA was studied by ABC immunohistology, ras gene mutation by PCR-RELP analysis.Results Histology,Nevin staging and operative methods were relevant to the prognosis of gallbladder cancer.The patient with stag IV,V gallbladder cancer had a poor prognosis;radical operations could prolong patients survival time.The mortal risk of patients with ras gene mutation was 1.62 times higher than that without ras gene mutation,with high overexpression of PCNA was 2.2 times higher than that with low expression of PCNA. Conclusions Differentiation degree, Nevin′s staging, mutation of ras gene and overexpresion of PCNA could be the prognostic factors in gallbladder cancer,and could help to select the operative procedure and to eluvate the surrival.