ABSTRACT
Objective@#To discuss the rationality of stage pT3 in the AJCC 8th TNM criteria of gallbladder carcinoma.@*Methods@#A retrospective study was performed to analyze the clinical and pathological data of 88 patients with pT3 gallbladder carcinoma admitted to Department of Second Biliary Surgery of Eastern Hepatobiliary Surgery Hospital, affiliated to Naval Medical University from May 2013 to September 2018.pT3 stage tumors were divided into two groups: (1) pT3a stage: tumors had penetrated serosa but not directly invaded liver and/or an adjacent organ or structure; (2) pT3b stage: tumor penetrating serosa and directly invaded liver and/or an adjacent organ or structure. There were 45 patients with pT3a stage, including 15 males and 30 females, aged 36 to 80 years, with a median age of 59 years; 43 patients with pT3b, including 24 males and 19 females, aged 41 to 78 years old, median aged 63 years old.Patients with pT3a and pT3b were further divided into two groups respectively: radical resection group and extended radical resection group according to surgical radicalization. Independent sample t-test was used for comparison between two groups with normal distribution measurement data. Wilcoxon rank sum test was used between groups of non-normally distributed measurement data.The comparison of the count data was performed by χ2 test or Fisher exact probability method. Survival analysis was performed using Kaplan-Meier method, and survival rate was compared using Log-rank test.@*Results@#(1)Serum total bilirubin(15.6(90.3)mmol/L), albumin(40.2(4.8)mmol/L), and CA19-9(132.90(455.78)U/ml) levels in pT3b patients were higher than that in pT3a patients(10.2(6.8)mmol/L, 41.8(4.9)mmol/L, 14.35(36.27)U/ml), respectively(Z=-3.816, -1.966, -3.739, all P<0.05),postoperative complication rate in pT3b patients(24.4%) was higher than that in pT3a patients(8.9%)(P<0.05),postoperative hospital stay(12(7)days) and overall hospital stay((26±17)days) of pT3b patients were longer than that of pT3a patients((10±5) days and (19±7)days) (P<0.05). (2) The 1-, 3-, 5-year survival rates of pT3b and pT3a patients were 53%,22%,22% and 69%, 46%,38%,and the median survival time was 13 months and 26 months, respectively. The difference in survival rates between the two groups was statistically significant(χ2=5.117, P=0.024). (3)The 1-, 3-year survival rates of extended radical resection group(n=19) and radical resection group(n=24) in the pT3b stage were 73%, 36% and 28%, 7%, respectively.The survival time was 20 months and 9 months,respectively,and the difference in survival rates between the two groups was statistically significant(χ2=4.976, P=0.026).@*Conclusions@#pT3 gallbladder carcinoma could be further subdivided into pT3a stage and pT3b stage based on the TNM criteria of AJCC 8th gallbladder carcinoma. Extended radical resection for pT3b gallbladder carcinoma should be further considered after comprehensive assessment of the patient′s basic condition and surgical tolerance.
ABSTRACT
Objective To analyze the clinical efficacy and toxic reaction of Tegafur,Gimeraciland Oteracil Potassium Capsule combined with Gemcitabine chemotherapy for patients with radical resection for advanced gallbladder carcinoma.Methods The clinical dataof 135 patients with advanced gallbladder cancer who were admitted to the 1 st Affiliated Hospital of Zhengzhou University and supported after the gastrectomy by the pathology from June 2007 to June 2012 were retrospectively analyzed.All patients were divided into three groups by different therapeutic regimens,operation groups (Radical resection or Extended radical resection of gallbladder carcinoma) with 47 cases,chemotherapy A group (Tegafur,Gimeracil and Oteracil Potassium Capsule combined with Gemcitabine chemotherapy after Radical resection or Extended radical resection of gallbladder carcinoma) with 52 cases,and chemotherapy B group (5-Fluorouracil combined with Oxaliplatin chemotherapy after Radical resection or Extended radical resection of gallbladder carcinoma) with 36 cases.We collected the dates of all patients with the median survival time and the 1,3 and 5-year survival rate after operation,and counted the rate of major toxic reaction after chemotherapy.Results There were no significant differences in the general date of three groups (sex,age,tumor size,CA19-9,CA125,TNM stages,with or without cholecystolithiasis,operation methods,operation complication),The chemotherapy A group and chemotherapy B group had no differenceswiththe median survival time and 1,3 and 5-year survival rate after operation.There were significant differences in the median survival time and 3,5-year survival rate after operation between the operation group and chemotherapy A group (or between the operation group and chemotherapy B group).There were significant differences in the rate of whole toxic reaction and the rate of toxic reaction beyond Ⅲ degree between chemotherapy A group and chemotherapy B group.Conclusions The treatment of Tegafur,Gimeracil and Oteracil Potassium Capsule combined with Gemcitabine chemotherapy for patients with radical resection of advanced gallbladder carcinoma has a lower rate of whole toxic reaction and rate of toxic reaction beyond Ⅲ degree than 5-Fluorouracil combined with Oxaliplatin chemotherapy,and for patients with advanced gallbladder carcinoma,the frontal treatment can obviously prolong the median survival time and effectively improve the 3 and 5-year survival rate after operation.