Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread

Kohya, Naohiko; Kono, Kenji; Miyazaki, Kohji

doi:10.3748/wjg.v16.i28.3567

Cited by 20 publications

(13 citation statements)

References 47 publications

(53 reference statements)

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“…Radical lymphadenectomy is recommended because the rate of LN metastasis in T2 tumors in GBC is quite high (range, 46.1-61.9%) and radical LN dissection improves long-term survival in patients with LN metastasis [24,27,29]. However, some groups advocate simple cholecystectomy alone as providing long-term survival in patients with T2 tumor, and others suggest that simple cholecystectomy may be justified by a subset analysis of patients with T2 tumor according to certain pathological criteria, such as depth of subserosal invasion and horizontal tumor spread in the subserosal layer [30][31][32][33]. Thus, if a pathological investigation could discriminate patients with favorable prognosis even by limited surgery for stage T2 GBC, these patients would be freed from extended radical surgery.…”

Section: Discussionmentioning

confidence: 93%

Tumor budding and dedifferentiation in gallbladder carcinoma: potential for the prognostic factors in T2 lesions

et al. 2011

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Dedifferentiation (DD) is often encountered in gallbladder carcinoma (GBC) and poor prognosis with budding (BD) has been reported for other malignancies. However, the features of DD and BD in GBC remain unclear. The purpose of this study was to clarify the features and prognostic potential of DD and BD in GBC. A total of 80 patients with GBC (excluding intramucosal cancer) were enrolled. DD was histopathologically evaluated as tumors in which the grade of the invasive front is higher than the grade at the surface. BD was defined as an isolated single cancer cell or a cluster of fewer than five cancer cells at the invasive front. Of the 80 patients, 47 (58.8%) were positive for BD and 33 (41.2%) were positive for DD. Both BD and DD correlated significantly with disease-specific survival in univariate analysis (P < 0.0001 and P = 0.0013, respectively), but they were not identified as independent prognostic factors by multivariate analysis. In univariate analysis according to T stage, both BD and DD correlated significantly with survival in patients with T2 (n = 32) tumor (P = 0.0011 and P = 0.0018, respectively), whereas no prognostic impact in patients with T1b (n = 8), T3 (n = 34), or T4 (n = 6) tumor. Both DD and BD are frequently observed in GBC and reflect prognosis, particularly for T2 lesions. Therefore, the status of BD and DD should be taken into consideration in pathological reports on GBC.

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Section: Discussionmentioning

confidence: 93%

Tumor budding and dedifferentiation in gallbladder carcinoma: potential for the prognostic factors in T2 lesions

et al. 2011

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“…Therefore, adequate surgical management for T2 gallbladder cancer has been of major clinical interest to surgeons. [3–7]…”

Section: Introductionmentioning

confidence: 99%

Tumor Location Is a Strong Predictor of Tumor Progression and Survival in T2 Gallbladder Cancer

Shindoh¹,

et al. 2015

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Objective To determine the prognostic impact of tumor location in gallbladder cancer. Summary Background Data Depth of tumor is a strong predictor of survival after curative resection of gallbladder cancer. However, the gallbladder has a unique anatomical relationship with the liver, and the clinical significance of tumor location remains unclear. Methods For 437 patients with gallbladder cancer resected at 4 international institutions, clinicopathologic characteristics and their association with survival were analyzed. Tumor location was defined as “hepatic side” or “peritoneal side”, and the prognostic significance of tumor location was evaluated. Results Among the 252 patients with T2 disease, patients with tumors on the hepatic side (T2h, n=99) had higher rates of vascular invasion, neural invasion, and nodal metastasis than patients with tumors on the peritoneal side (T2p, n=153) (51% vs. 19%, 33% vs. 8%, and 40% vs. 17%, respectively, P<0.01 for all). After a median follow-up of 58.9 months, 3-year and 5-year survival rates were 52.1% and 42.6%, respectively, for T2h tumors and 73.7% and 64.7%, respectively, for T2p tumors (P=0.0006). No such differences were observed in T1 or T3 tumors. Multivariate analysis confirmed the independent association of hepatic-side location with survival in T2 tumors (hazard ratio, 2.7; 95% CI, 1.7 to 4.2; P<0.001). This subclassification of T2 tumors predicted recurrence in the liver (23% vs. 3%, P=0.003) and distant lymph nodes (16% vs. 3%, P=0.019) even after radical resection. Conclusions After curative resection of T2 gallbladder cancer, tumor location predicts the pattern of recurrence and survival.

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“…When dealing with pT2 gallbladder cancer, hepatectomy is valuable in 2 respects: (1) ensuring an adequate tumor‐free margin on the liver side, and (2) as a means of prophylactic resection to prevent liver metastasis. In Japan, gallbladder resection (for ensuring an adequate margin on the liver side) and segment 4a and 5 (S4a+5) hepatectomy (for removal of microscopic foci of tumor in the area perfused with gallbladder veins) have been primarily applied []. There is, however, no definitive conclusion as to which of these 2 procedures is more useful.…”

Section: Introductionmentioning

confidence: 99%

Gallbladder bed resection or hepatectomy of segments 4a and 5 for pT2 gallbladder carcinoma: analysis of Japanese registration cases by the study group for biliary surgery of the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery

Horiguchi

Miyakawa

Ishihara

et al. 2013

J Hepato Biliary Pancreat

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Purpose Hepatectomy of segments 4a and 5 (S4a?5) is the recommended treatment for pT2 gallbladder cancer. However, gallbladder bed resection is also occasionally used. Using nationwide data from the Japanese Biliary Tract Cancer Registry and a questionnaire survey, we retrospectively compared these 2 methods of treatment. Method The study involved 85 patients with pT2, pN0 gallbladder cancer (55 treated with gallbladder bed resection, and 30, with S4a?5 hepatectomy). The prognosis and mode of tumor recurrence following treatment were analyzed retrospectively, with overall survival as the endpoint. Results The 5-year survival rate did not differ significantly between the 2 groups. Univariate analysis showed that bile duct resection and perineural tumor invasion were significant prognostic factors, but the extent of hepatectomy, location of the major intramural tumor, regional lymph node excision, and histological type were not.Multivariate analysis identified perineural tumor invasion as a significant prognostic factor. Recurrence occurred most frequently in both lobes than S4a?5 of the liver following gallbladder bed resection. Conclusion In the present study of cases of Japanese Biliary Tract Cancer Registry, it was not possible to conclude that S4a?5 hepatectomy was superior to gallbladder bed resection.

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Rational therapeutic strategy for T2 gallbladder carcinoma based on tumor spread

Cited by 20 publications

References 47 publications

Tumor budding and dedifferentiation in gallbladder carcinoma: potential for the prognostic factors in T2 lesions

Tumor budding and dedifferentiation in gallbladder carcinoma: potential for the prognostic factors in T2 lesions

Tumor Location Is a Strong Predictor of Tumor Progression and Survival in T2 Gallbladder Cancer

Gallbladder bed resection or hepatectomy of segments 4a and 5 for pT2 gallbladder carcinoma: analysis of Japanese registration cases by the study group for biliary surgery of the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery

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