【摘 要】
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Objectives: Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis.Radical resection remains the only therapeutic option for improving survival in pa
【机 构】
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Department of Hepatobiliary Surgery,First Affiliated Hospital of Xi'an Jiaotong University,Xi'an,S
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Objectives: Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis.Radical resection remains the only therapeutic option for improving 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: 285 patients with stage Ⅳ GBC were analyzed retrospectively 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 8.3%,2.6%,and 1.3%,respectively.Ascites,M status,and surgery were identified as independent risk factors influencing prognosis.The mean survival time (MST) was significantly higher in patients undergoing R0 resection compared with R1/2 resection (6.0 vs 2.7 months; P < 0.001).In subgroup analyses,stage IVA patients benefited from R0 resection (MST for R0 vs R1/2,11.0 vs 3.7 months; P= 0.04),while R0 resection provided a significant survival benefit over R1/2 resection in stage IVB patients without distant metastasis (MST for R0 vs R1/2,6.0 vs 3.0 months; P= 0.016).Conclusion: Ascites,M status,and surgery are independent risk factors influencing prognosis in patients with stage IV GBC.N2 lymph node metastasis does not preclude curative resection,and R0 resection should therefore be considered in highly selected patients with stage Ⅳ GBC.
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