Influence of curative-intent resection with textbook outcomes on long-term prognosis of gall-bladder carcinoma:a national multicenter study
Objective To investigate the influence of curative-intent resection with textbook outcomes of liver surgery(TOLS)on long-term prognosis of gallbladder carcinoma(GBC).Methods The retrospective cohort study was conducted.The clinicopathological data of 824 patients with GBC in the national multicenter database of Biliary Surgery Group of Elite Group of Chinese Journal of Digestive Surgery,who were admitted to 15 medical centers from January 2014 to January 2021,were collected.There were 285 males and 539 females,aged(62±11)years.According to the evalua-tion criteria of TOLS,patients were divided into those who achieved TOLS and those who did not achieve TOLS.Measurement data with normal distribution were represented as Mean±SD,and com-parison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(Q1,Q3),and comparison between groups was conducted using the Mann-Whitney U test.Count data were described as absolute numbers,and comparison between groups was conducted using the chi-square test.Comparison of ordinal data were conduc-ted using the Mann-Whitney U test.The Kaplan-Meier method was used to calculate survival rate and draw survival curve,and the Log-rank test was used for survival analysis.The COX stepwise regression model with backward Wald method was used for univariate and multivariate analyses.Results(1)Achievement of TOLS.Of the 824 patients undergoing curative-intent resection for GBC,there were 510 cases achieving TOLS and 314 cases not achieving TOLS.(2)Follow-up.Of the 824 patients undergoing curative-intent resection for GBC,after excluding112 deaths within 90 days after discharge,712 cases were included for the survival analysis.The median follow-up time,median overall survival time and 5-year overall survival rate of the 510 patients achieving TOLS were 22.1(11.4,30.1)months,47.6(30.6,64.6)months and 47.5％.The median follow-up time,median overall survival time and 5-year overall survival rate of the 202 patients not achieving TOLS were 14.0(6.8,25.5)months,24.3(20.0,28.6)months and 21.0％.There was a significant difference in overall survival between patients achieving TOLS and patients not achieving TOLS(x2=58.491,P＜0.05).(3)Analysis of factors influencing prognosis of patients.Results of multivariate analysis showed that TOLS,carcinoembryonic antigen(CEA),CA19-9,poorly differentiation of tumor,T2 stage of eighth edition of American Joint Committee on Cancer(AJCC)staging,T3 and T4 stage of eighth edition of AJCC staging,N1 stage of the eighth edition of AJCC staging,N2 stage of the eighth edition of AJCC staging,adjuvant therapy were independent factors influencing overall survival time of patients undergoing curative-intent resection for GBC(hazard ratio=0.452,1.479,1.373,1.612,1.455,1.481,1.835,1.978,0.538,95％confidence interval as 0.352-0.581,1.141-1.964,1.052-1.791,1.259-2.063,1.102-1.920,1.022-2.147,1.380-2.441,1.342-2.915,0.382-0.758,P＜0.05).Conclusion Patients under-going curative-intent resection for GBC with TOLS can achieve better long-term prognosis.
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