Korean J Hepatobiliary Pancreat Surg.  2015 Feb;19(1):11-16. 10.14701/kjhbps.2015.19.1.11.

Survival analysis following resection of AJCC stage III gallbladder carcinoma based on different combinations of T and N stages

• Hwang KY
• Yoon YI
• Hwang S
• Ha TY
• Ahn CS
• Kim KH
• Moon DB
• Song GW
• Jung DH
• Lee YJ
• Park KM
• Lee SG

• KMID: 1802234
• DOI: http://doi.org/10.14701/kjhbps.2015.19.1.11

Abstract

BACKGROUNDS/AIMS
According to 7th AJCC TNM staging system, gallbladder carcinoma (GBC) with lymph node (LN) metastasis is classified as N1 or N2; thus making the stage IIIB (N1) or IVB (N2). Stage IIIB consists of N1 status with wide coverage of T1-3, but T3N1 group often showed poorer outcomes than T1-2N1 groups. This study intended to assess post-resection prognosis of T3N1 versus other stage III subgroups.
METHODS
We selected 103 patients from our institutional database of GBC who underwent R0 resection between July 1996 and June 2009 and whose GBC was confined to stage T3N0, T1-3N1 or T1-3N2. These patients were stratified into five groups, namely, T3N0 (n=26), T1N1 (n=13), T2N1 (n=35), T3N1 (n=20) and T1-3N2 (n=9), and were followed for > or =5 years or until death.
RESULTS
Surgical procedures were minor liver resection (n=53), minor liver resection with bile duct resection (n=23), major liver resection (n=12), major liver resection with bile duct resection (n=5), and hepatopancreatoduodenectomy (n=12). Mean follow-up period was 57.2+/-68.5 months. Overall 5-year survival rate based on all-cause death and cancer-associated death, respectively, was 57.7% and 60.6% in T3N0, 15.4% and 15.4% in T1N1 (n=13), 28.6% and 28.6% in T2N1 (n=35), 5.0% and 5.7% in T3N1 (n=20), and 22.2% and 22.2% in T1-3N2. The survival outcome of T3N1 group was the poorest among the four stage III groups and was comparable to that of stage IVB (p=0.53).
CONCLUSIONS
The prognosis of T3N1 GBC is unusually poor even after R0 resection, thus we suggest extensive LN dissection may be necessary in patients with T3 tumors for accurate prognostic evaluation and radical removal of potential nodal micrometastasis. Further validation of this result is necessary in large patient populations from multiple centers.

Keyword

Gallbladder carcinoma; Survival analysis; Resection; Lymph node metastasis

MeSH Terms

Bile Ducts
Follow-Up Studies
Gallbladder*
Humans
Liver
Lymph Nodes
Neoplasm Metastasis
Neoplasm Micrometastasis
Neoplasm Staging
Prognosis
Survival Analysis*
Survival Rate

Figure

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  Fig. 1 Comparison of the overall survival curves of the five groups based on all-cause death.

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  Fig. 2 Comparison of the overall survival curves of the five groups based on tumor recurrence-related death.

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