Survival of a cohort of patients with Intermediate and advanced gall bladder cancer treated with a prospective therapeutic protocol

Abstract

Purpose:To evaluate the results of a prospective therapeutic protocol with long-term follow up in terms of survival rates in a cohort of patients treated with Intermediate and Advanced GBC (GBC). Methods: Prospective cohort of patients with intermediate and advanced stages of GBC treated between 1996 and 2006. All cases were treated with a partial hepatic segmentectomy on segments IVb and V and a regional lymph node dissection and six cycles of out-patient chemotherapy (5-FU and leukovorin). With an average follow-up of 31.5 months, the morbidity, operative mortality, hepatic and lymphatic infiltration and actuarial survival were measured. Descriptive statistics were applied as well as bivariate analysis applying Fisher's exact test and non-parametrical tests and Kaplan Meier survival curves. Also logistic regression and proportional risk of Cox were applied. Results: 40 patients were included in this protocol, with an average age of 59.5 years (40-85 years), of which 28 were women (70%). Depth of wall infiltration: muscular 8 patients (20%), subserosal 12 patients (30%), serosal 12 patients (30%) and perivesicular adipose tissue 8 patients (20%). The series morbidity was 27.5%. There was no operative mortality. The chemotherapy was well tolerated. The overall actuarial survival in the series was 50% at 60 months. Conclusion: Our protocol treatment has morbidity, mortality and survival rates similar to previously reported series. Key words: Gallbladder Neoplasms. Hepatectomy. Chemotherapy, Adjuvant. RESUMOObjetivo: Avaliar os resultados de resultados da aplicação de um protocolo terapêutico de natureza prospectiva, com seguimento em longo prazo nos termos de taxas de sobrevivência em uma coorte de pacientes operados com carcinoma vesícula biliar (CVB) intermédio e avançado. Métodos: A coorte prospectiva de pacientes com estágios intermediários e avançados de CVB tratados entre 1996 e 2006. Todos os casos foram tratados com uma segmentectomia hepática parcial em segmentos IVb e V e uma dissecção linfonodal regional e seis ciclos de quimioterapia de ambulatório (5-FU e leukovorin). Com um tempo de seguimento médio de 31,5 meses, a morbidade, mortalidade operatória, hepático e infiltração linfática e atuarial de sobrevida foram medidas. Estatísticas descritivas foram aplicadas, bem como análise bivariada aplicando o teste exato de Fisher, testes não-paramétricos, curvas de sobrevida Kaplan Meier e técnica de regressão logística e risco proporcional de Cox. Resultados: Foram incluídos 40 pacientes neste protocolo, com uma média de idade de 59,5 anos (40-85 anos), dos quais 28 eram mulheres (70%). Profundidade de infiltração parede: muscular 8 pacientes (20%), subserosal 12 pacientes (30%), serosas 12 pacientes (30%) e perivesicular no tecido adiposo, 8 pacientes (20%). A série morbidade foi de 27,5%. Não houve mortalidade operatória. A quimioterapia foi bem tolerada. A sobrevida global atuarial da série foi de 50% em 60 meses. Conclusão: Nosso protocolo tem tratamento morbidade, mortalidade e taxas de sobre...

Survival analysis of patients with bladder cancer, life table approach

“…In a study by Manterola et al ., the survival accumulation at the end of five years was reported as 50%. [23] Also, in another study which was carried out on 333 patients treated by radio therapy, the survival accumulations at the end of five and ten years were calculated as 57 and 54% respectively. [24] Another multi ethnic study showed that the overall survival of bladder cancer was 66, 61, 59, and 52% in Japanese, Caucasian, Filipino, and Hawaiian patients respectively.…”

“…Type of the treatment is highly effective on the rate of survival; the accumulation of survival rate at the end of five years increases up to 80% in patients who undergo the colon operation. [23] It is quite obvious that the type of treatment based on the patients’ conditions such as sex, severity of the disease, and age is highly influential on the prognosis of the disease. However, the present study did not show the effect of sex and severity of the disease on the survival rate due to the small number of the patients in sub categories.…”

¿Cuál es el Rol de la Cirugía en el Tratamiento de un Paciente con Cáncer de la Vesícula Biliar Estadio IIIb?

“…En pacientes con T3 y T4 se evalúa caso a caso la indicación de cirugía. De este modo; obtuvimos SV actuarial a 5 años de 39% y 12,5% para CaVB T3 y T4 respectivamente; aún cuando la mediana real de SV para ambos fue de 14,5 y 5,5 meses respectivamente (Manterola et al, 2010).…”

“…Entre las que destacan la indicación de la colecistectomía extendida en tumores pT1a y pT1b1 y asociado a esto, el rol de los SRA (Roa et al, 2013); el rol de la colecistectomía extendida en pacientes con invasión de la serosa o más allá de ésta (de Aretxabala, et al, 2009;Manterola et al, 2010); la utilidad de la quimio radioterapia (de Aretxabala, et al, 1999;de Aretxabala, et al, 2009;Lee et al, 2012a); etc.…”

“…Pero, volviendo a las interrogantes que planteamos intentar aclarar a la luz de la evidencia actual, podemos señalar lo siguiente: en relación a la indicación de reintervención nos parece que la respuesta es sí, con base en: nuestra propia experiencia (Manterola et al, 2010); una GPC de origen coreano (Lee et al, 2014); y tres EO (Ausania et al, 2013;Choi et al;Goetze & Paolucci). Es decir con base en un nivel de evidencia 4.…”