Surgical procedure determination based ontumor-node-metastasis staging of gallbladder cancer

AIM: To investigate the impact of surgical procedures on prognosis of gallbladder cancer patients classified with the latest tumor-node-metastasis(TNM) staging system.METHODS: A retrospective study was performed by reviewing 152 patients with primary gallbladder carcinoma treated at Peking Union Medical College Hospital from January 2003 to June 2013. Postsurgical follow-up was performed by telephone and outpatient visits. Clinical records were reviewed and patients were grouped based on the new edition of TNM staging system(AJCC, seventh edition, 2010). Prognoses were analyzed and compared based on surgical operations including simple cholecystectomy, radical cholecystectomy(or extended radical cholecystectomy), and palliative surgery. Simple cholecystectomy is, by definition, resection of the gallbladder fossa. Radical cholecystectomy involves a wedge resection of the gallbladder fossa with 2 cm nonneoplastic liver tissue; resection of a suprapancreatic segment of the extrahepatic bile duct and extended portal lymph node dissection may also be considered based on the patient's circumstance. Palliative surgery refers to cholecystectomy with biliary drainage. Data analysis was performed with SPSS 19.0 software. KaplanMeier survival analysis and Logrank test were used for survival rate comparison. P < 0.05 was consideredstatistically significant.RESULTS: Patients were grouped based on the new 7th edition of TNM staging system, including 8 cases of stage 0, 10 cases of stage Ⅰ, 25 cases of stage Ⅱ, 21 cases of stage ⅢA, 21 cases of stage ⅢB, 24 cases of stage ⅣA, 43 cases of stage ⅣB. Simple cholecystectomy was performed on 28 cases, radical cholecystectomy or expanded gallbladder radical resection on 57 cases, and palliative resection on 28 cases. Thirty-nine cases were not operated. Patients with stages 0 and Ⅰ disease demonstrated no statistical significant difference in survival time between those receiving radical cholecystectomy and simple cholecystectomy(P = 0.826). The prognosis of stage Ⅱ patients with radical cholecystectomy was better than that of simple cholecystectomy. For stage Ⅲ patients, radical cholecystectomy was significantly superior to other surgical options(P < 0.05). For stage ⅣA patients, radical cholecystectomy was not better than palliative resection and non-surgical treatment. For stage ⅣB, patients who underwent palliative resection significantly outlived those with non-surgical treatment(P < 0.01)CONCLUSION: For stages 0 and Ⅰ patients, simple cholecystectomy is the optimal surgical procedure, while radical cholecystectomy should be actively operated for stages Ⅱ and Ⅲ patients.

AIM To compare survival and recurrence in hepatocellularcarcinoma （HCC） patients who did or did notreceive adjuvant transarterial chemoembolization（TACE）.METHODS： A consecutive sample of 229 patients whounderwent curative resection between March 2007and March 2010 in our hospital was included. Of these229 patients, 91 （39.7%） underwent curative resectionfollowed by adjuvant TACE and 138 （60.3%） underwentcurative resection alone. In order to minimize confoundsdue to baseline differences between the twopatient groups, comparisons were conducted betweenpropensity score-matched patients. Survival data andrecurrence rates were compared using the Kaplan-Meier method. Independent predictors of overall survivaland recurrence were identified using Cox proportionalhazard regression.RESULTS： Among 61 pairs of propensity scorematchedpatients, the 1-, 2-, and 3-year overall survivalrates were 95.1%, 86.7%, and 76.4% in the TACEgroup and 86.9%, 78.5%, and 73.2% in the controlgroup, respectively. At the same time, the TACE andcontrol groups also showed similar recurrence rates at1 year （13.4% vs 24.8%）, 2 years （30.6% vs 32.1%）,and 3 years （40.1% vs 34.0%）. Multivariate Coxregression identified serum alpha-fetoprotein level ≥400 ng/mL and tumor size 〉 5 cm as independent riskfactors of mortality （P 〈 0.05）.CONCLUSION： As postoperative adjuvant TACE doesnot improve overall survival or reduce recurrence inHCC patients, further study is needed to clarify itsclinical benefit.