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Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer

Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve survival in patients with GBC. This study aimed to analyze the prognostic factors in patients with stage Ⅳ GBC and to identify a...

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Published in:Chronic diseases and translational medicine 2019-09, Vol.5 (3), p.188-196
Main Authors: Chen, Chen, Wang, Lin, Zhang, Rui, Li, Qi, Zhao, Ya-Ling, Zhang, Guan-Jun, Li, Wen-Zhi, Geng, Zhi-Min
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description Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve 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. A total of 285 patients with stage Ⅳ GBC were retrospectively analyzed 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. The 1-, 3-, and 5-year overall survival rates were 6.6% (15/229), 0.9% (2/229), and 0 (0/229), respectively. Ascites (relative risk [RR] = 1.631, 95% confidence interval [CI]: 1.221–2.180, P = 0.001), pathological grade (RR = 1.337, 95% CI: 1.050–1.702, P = 0.018), T stage (RR = 1.421, 95% CI: 1.099–1.837, P = 0.000), M stage (RR = 1.896, 95% CI: 1.409–2.552, P = 0.000), and surgery (RR = 1.542, 95% CI: 1.022–2.327, P = 0.039) were identified as independent risk factors influencing prognosis. The median survival time (MST) was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection (6.0 vs. 2.7 months; P 
doi_str_mv 10.1016/j.cdtm.2019.08.004
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A single-center analysis of patients with stage Ⅳ gallbladder cancer</title><source>Publicly Available Content Database</source><source>Wiley Open Access Journals</source><source>PubMed Central</source><creator>Chen, Chen ; Wang, Lin ; Zhang, Rui ; Li, Qi ; Zhao, Ya-Ling ; Zhang, Guan-Jun ; Li, Wen-Zhi ; Geng, Zhi-Min</creator><creatorcontrib>Chen, Chen ; Wang, Lin ; Zhang, Rui ; Li, Qi ; Zhao, Ya-Ling ; Zhang, Guan-Jun ; Li, Wen-Zhi ; Geng, Zhi-Min</creatorcontrib><description>Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve 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. A total of 285 patients with stage Ⅳ GBC were retrospectively analyzed 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. The 1-, 3-, and 5-year overall survival rates were 6.6% (15/229), 0.9% (2/229), and 0 (0/229), respectively. Ascites (relative risk [RR] = 1.631, 95% confidence interval [CI]: 1.221–2.180, P = 0.001), pathological grade (RR = 1.337, 95% CI: 1.050–1.702, P = 0.018), T stage (RR = 1.421, 95% CI: 1.099–1.837, P = 0.000), M stage (RR = 1.896, 95% CI: 1.409–2.552, P = 0.000), and surgery (RR = 1.542, 95% CI: 1.022–2.327, P = 0.039) were identified as independent risk factors influencing prognosis. The median survival time (MST) was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection (6.0 vs. 2.7 months; P &lt; 0.001). In subgroup analyses, stage ⅣA patients benefited from R0 resection (MST for R0 vs. R1/R2, 11.0 vs. 4.0 months; P = 0.003), while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage ⅣB GBC without distant metastasis (MST for R0 vs. R1/R2, 6.0 vs. 3.0 months; P = 0.007). Ascites, pathological grade, T stage, M stage, and surgery were independent risk factors influencing prognosis in patients with stage IV GBC. N2 lymph node metastasis did not preclude curative resection, and radical resection should be considered in patients with stage Ⅳ GBC without distant metastasis once R0 margin was achieved.</description><identifier>ISSN: 2095-882X</identifier><identifier>ISSN: 2589-0514</identifier><identifier>EISSN: 2589-0514</identifier><identifier>DOI: 10.1016/j.cdtm.2019.08.004</identifier><identifier>PMID: 31891130</identifier><language>eng</language><publisher>United States: Elsevier B.V</publisher><subject>Gallbladder cancer ; Original ; Prognosis ; Surgery ; Tumor-node-metastasis (TNM) stage</subject><ispartof>Chronic diseases and translational medicine, 2019-09, Vol.5 (3), p.188-196</ispartof><rights>2019 Chinese Medical Association</rights><rights>2019 The Authors. Chronic Diseases and Translational Medicine published by John Wiley &amp; Sons, Ltd on behalf of Chinese Medical Association</rights><rights>2019 Chinese Medical Association. Production and hosting by Elsevier B.V. on behalf of KeAi Communications Co., Ltd.</rights><rights>Copyright © Wanfang Data Co. Ltd. All Rights Reserved.</rights><rights>2019 Chinese Medical Association. 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A single-center analysis of patients with stage Ⅳ gallbladder cancer</title><title>Chronic diseases and translational medicine</title><addtitle>Chronic Dis Transl Med</addtitle><description>Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve 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. A total of 285 patients with stage Ⅳ GBC were retrospectively analyzed 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. The 1-, 3-, and 5-year overall survival rates were 6.6% (15/229), 0.9% (2/229), and 0 (0/229), respectively. Ascites (relative risk [RR] = 1.631, 95% confidence interval [CI]: 1.221–2.180, P = 0.001), pathological grade (RR = 1.337, 95% CI: 1.050–1.702, P = 0.018), T stage (RR = 1.421, 95% CI: 1.099–1.837, P = 0.000), M stage (RR = 1.896, 95% CI: 1.409–2.552, P = 0.000), and surgery (RR = 1.542, 95% CI: 1.022–2.327, P = 0.039) were identified as independent risk factors influencing prognosis. The median survival time (MST) was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection (6.0 vs. 2.7 months; P &lt; 0.001). In subgroup analyses, stage ⅣA patients benefited from R0 resection (MST for R0 vs. R1/R2, 11.0 vs. 4.0 months; P = 0.003), while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage ⅣB GBC without distant metastasis (MST for R0 vs. R1/R2, 6.0 vs. 3.0 months; P = 0.007). Ascites, pathological grade, T stage, M stage, and surgery were independent risk factors influencing prognosis in patients with stage IV GBC. 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A single-center analysis of patients with stage Ⅳ gallbladder cancer</atitle><jtitle>Chronic diseases and translational medicine</jtitle><addtitle>Chronic Dis Transl Med</addtitle><date>2019-09</date><risdate>2019</risdate><volume>5</volume><issue>3</issue><spage>188</spage><epage>196</epage><pages>188-196</pages><issn>2095-882X</issn><issn>2589-0514</issn><eissn>2589-0514</eissn><abstract>Most patients with gallbladder cancer (GBC) present with advanced-stage disease and have a poor prognosis. Radical resection remains the only therapeutic option to improve 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. A total of 285 patients with stage Ⅳ GBC were retrospectively analyzed 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. The 1-, 3-, and 5-year overall survival rates were 6.6% (15/229), 0.9% (2/229), and 0 (0/229), respectively. Ascites (relative risk [RR] = 1.631, 95% confidence interval [CI]: 1.221–2.180, P = 0.001), pathological grade (RR = 1.337, 95% CI: 1.050–1.702, P = 0.018), T stage (RR = 1.421, 95% CI: 1.099–1.837, P = 0.000), M stage (RR = 1.896, 95% CI: 1.409–2.552, P = 0.000), and surgery (RR = 1.542, 95% CI: 1.022–2.327, P = 0.039) were identified as independent risk factors influencing prognosis. The median survival time (MST) was significantly higher in patients undergoing R0 resection than in those undergoing R1/R2 resection (6.0 vs. 2.7 months; P &lt; 0.001). In subgroup analyses, stage ⅣA patients benefited from R0 resection (MST for R0 vs. R1/R2, 11.0 vs. 4.0 months; P = 0.003), while R0 resection had a significant survival benefit than R1/R2 resection in patient with stage ⅣB GBC without distant metastasis (MST for R0 vs. R1/R2, 6.0 vs. 3.0 months; P = 0.007). Ascites, pathological grade, T stage, M stage, and surgery were independent risk factors influencing prognosis in patients with stage IV GBC. N2 lymph node metastasis did not preclude curative resection, and radical resection should be considered in patients with stage Ⅳ GBC without distant metastasis once R0 margin was achieved.</abstract><cop>United States</cop><pub>Elsevier B.V</pub><pmid>31891130</pmid><doi>10.1016/j.cdtm.2019.08.004</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record>
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subjects Gallbladder cancer
Original
Prognosis
Surgery
Tumor-node-metastasis (TNM) stage
title Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer
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