Objective: To investigate the clinical value of extended radical resection for stage pT3 gallbladder cancer (GBC). Methods: The clinical and pathological data of 323 patients with stage pT3 GBC who received regional radical resection or extended radical resection in 7 domestic hepatobiliary centers in China from January 2013 to December 2018 were retrospectively analyzed. The propensity score matching method was used to select 36 cases in each of the regional radical resection group (group A1) and the extended radical resection group (group B1). The surgical indicators and overall survival rates of the two groups were compared, and prognostic factors were analyzed. Results: The number of positive lymph nodes [2(0,3)] and the total number of lymph nodes removed [3(1,4)] in group B1 were both higher than those in group A1 [1(0,1), 4(2,7)] (all P<0.05). There was no significant difference in other clinical and pathological factors between the two groups (all P>0.05). The 1, 3, and 5-year survival rates of group A1 were 75%, 44%, and 29%, respectively, which were significantly higher than those of group B1 of 50%, 15%, and 11% (χ(2)=11.311, all P<0.001). Extensive radical resection (HR=2.161, 95%CI: 1.222-3.821), hepatic parenchymal invasion (HR=2.324, 95%CI: 1.305-4.139), positive lymph node rate ≥1/3 (HR=2.927, 95%CI: 1.641-5.220), and ⅢB/ⅣB staging (HR=3.325, 95%CI: 1.750-6.320) are risk factors for the prognosis of GBC patients (all P<0.05), of which extended radical resection (HR=1.969, 95%CI: 1.083-3.581) was an independent risk factor for prognosis (P<0.05). When the ratio of positive lymph nodes was<1/3 and the tumor invaded the hepatic parenchyma, the overall survival rate of group B1 was significantly lower than that of group A1 (all P<0.05). Conclusions: The overall survival rate in patients with stage pT3 GBC whose lymph node positive rate<1/3 and/or hepatic parenchymal invaded cannot be improved by extended radical resection. Extended radical resection is an independent risk factor for patient prognosis.
目的： 探讨pT3期胆囊癌（GBC）行扩大根治术的临床价值。 方法： 回顾性分析2013年1月至2018年12月国内7家肝胆中心接受区域性根治术和扩大性根治术的323例pT3期GBC患者的临床和病理资料，采用倾向性评分匹配法选取区域性根治术组（A1组）和扩大性根治术组（B1组）各36例，比较两组患者手术指标和总体生存情况，并进行预后因素分析。 结果： B1组阳性淋巴结个数[2（0，3）枚]和切除淋巴结总数[3（1，4）枚]均高于A1组[1（0，1）枚，4（2，7）枚）]（均P<0.05），两组间其他临床及病理因素的比较差异均无统计学意义（均P>0.05）。A1组1、3、5年生存率明显高于B1组，分别为75%、44%、29%和50%、15%、11%（χ(2)=11.311，均P<0.001）。扩大性根治术（HR=2.161，95%CI：1.222~3.821）、肝脏侵犯（HR=2.324，95%CI：1.305~4.139）、阳性淋巴结比率≥1/3（HR=2.927，95%CI：1.641~5.220）和ⅢB/ⅣB分期（HR=3.325，95%CI：1.750~6.320）是GBC患者预后的危险因素（均P<0.05），扩大性根治术（HR=1.969，95%CI：1.083~3.581）是预后的独立危险因素（P<0.05）。阳性淋巴结比率<1/3和肿瘤侵及肝脏时B1组的总体生存率明显低于A1组（均P<0.05）。 结论： 对阳性淋巴结比率<1/3和（或）肿瘤侵及肝脏的pT3期GBC施行扩大根治术并不能提高患者的总体生存率，扩大性根治术是患者预后的独立危险因素。.
Keywords: Expanded radical resection; Gallbladder cancer; Multicenter retrospective study; pT3 stage.