title: New prognostic factor influencing long-term survival of patients with advanced gallbladder carcinoma.
abstract: BACKGROUND
  Although the safety of operations has generally improved in recent years, the mortality of extended operations for advanced gallbladder carcinoma (GBC) remains high, and the outcomes of patients with advanced GBC requiring major surgery are poor. In this study, a newly formulated original stage classification of advanced GBC was evaluated to clarify prognostic factors affecting long-term survival.
  
  
  METHODS
  A total of 149 patients with resected GBC infiltrating beyond the propria muscle layer were analyzed retrospectively. These patients were classified into F0 (n = 50), F1 (n = 38), F2 (n = 38), and F3 (n = 23) according to the number of positive histopathologic factors, consisting of direct invasion to the liver, invasion to the hepatoduodenal ligament, and lymph node metastasis. Overall survival rates were compared with the Union Internationale Contre le Cancer TNM classification (6th edition).
  
  
  RESULTS
  Overall 5-year survival rates of patients with F0, F1, F2, and F3 were 60%, 35%, 5%, and 0%, respectively. Significant differences were observed, except between F2 and F3. In 38 patients with F1, there were no significant differences between 13 patients with direct invasion to the liver, 4 patients with invasion to the hepatoduodenal ligament, and 21 patients with lymph node metastasis. Multivariate analysis revealed that F classification was the most important independent risk factor to predict survival.
  
  
  CONCLUSIONS
  Patients with advanced GBC are expected to survive long if only 1 of hepatic invasion, hepatoduodenal ligament invasion, or lymph node metastasis is positive.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Itabashi-ku, Tokyo, Japan. f-miura@med.teikyo-u.ac.jp
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Takehide
authors.initials: T
authors.lastname: Asano
authors.forename: Hodaka
authors.initials: H
authors.lastname: Amano
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Toyota
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kato
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takami
authors.forename: Gaku
authors.initials: G
authors.lastname: Ohira
authors.forename: Hisahiro
authors.initials: H
authors.lastname: Matsubara
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures; D002763:Cholecystectomy; D013505:Digestive System Surgical Procedures; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008022:Ligaments / Q000473:pathology; D008113:Liver Neoplasms / Q000556:secondary; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D013997:Time Factors