Objective To summarize the development of gallbladder carcinoma related resistance genes and targeted therapy. Methods Domestic and international publications online involving resistance genes and targeted therapy of gallbladder carcinoma in recent years were collected and reviewed. Results Recent studies had shown that chemotherapy drug resistance of gallbladder carcinoma mainly involved lysosome protein transmembrane β4 （LAPTM4B） gene， NF-E2-related factor 2 （Nrf2） gene， and cancer stem cells （CSCs）. While the latest gene targets of treatment for gallbladder carcinoma mainly involved LAPTM4B， Nemo-like kinase （NLK）， tissue factor way inhibitor-2 （TFPI-2）， vascular endothelial growth factor-D （VEGF-D）， epidermal growth factor receptor （EGFR）， and melanoma differentiation-associated gene 7/interleukin 24 （mda-7/IL-24） gene. Conclusion The research involving resistance genes and targeted therapy of gallbladder carcinoma has make a certain progress， which broaden the concept of traditional treatment of gallbladder carcinoma.
目的 评价CT及MRI在中晚期胆囊癌周围脏器侵袭和转移中的诊断价值。方法 回顾性分析我院2003年3月至2010年6月期间收治的经手术病理证实的中晚期胆囊癌患者45例，所有患者术前均同时行CT和MRI检查。结果 ①在诊断胆囊癌方面，CT诊断符合率为93.33% （42/45），MRI诊断符合率为88.89% （40/45），二者比较差异无统计学意义（χ2=0.287 2，P＞0.05）。②在诊断胆囊癌转移的敏感度方面，肝脏直接浸润和转移诊断方面CT为72.00% （18/25），MRI为92.00% （23/25）；胆管受侵诊断方面CT为83.33% （5/6），MRI为100% （6/6）；胰腺转移诊断方面CT为100% （3/3），MRI为100% （3/3）；淋巴结转移诊断方面CT为70.00% （7/10），MRI为90.00% （9/10）；腹膜、网膜转移诊断方面CT为33.33% （1/3），MRI为33.33% （1/3）。诊断胆囊癌转移的总诊断符合率CT为72.34%（34/47），MRI为89.36% （42/47），MRI明显高于CT （χ2=4.083 3，P＜0.05）。结论 MRI在诊断胆囊癌方面与CT相当，但在诊断肿瘤侵犯邻近器官及转移方面MRI略优于CT。
３０ ｐａｔｉｅｎｔｓ ｗｉｔｈ ｐｒｉｍａｒｙ ｃａｒｃｉｎｏｍａ ｏｆ ｇａｌｌｂｌａｄｄｅｒ ｗｅｒｅ ｔｒｅａｔｅｄ ｓｕｒｇｉｃａｌｌｙ ｆｒｏｍ １９８７ ｔｏ １９９４． Ｔｈｅ ｒｅｓｕｌｔｓ ｓｈｏｗｅｄ ｔｈｅ ｍｉｓｄｉａｇｎｏｓｉｓ ｒａｔｅｓ ｏｆ ｇａｌｌｂｌａｄｄｅｒ ｃａｎｃｅｒ ａｎｄ ｏｆ ｃａｎｃｅｒ ｗｉｔｈ ｇａｌｌｂｌａｄｄｅｒ ｓｔｏｎｅｓ ｗｅｒｅ ｈｉｇｈ． Ｍｏｓｔ ｏｆ ｐｒｉｍａｒｙ ｃａｒｃｉｎｏｍａ ｉｎ ｔｈｉｓ ｓｅｒｒｉｅｓ ｗｅｒｅ ａｄｅｎｏｃａｒｃｉｎｏｍａｓ． Ａｌｓｏ ｐｒｉｍａｒｙ ｇａｌｌｂｌａｄｄｅｒ ｃａｒｃｉｎｏｍａ ｃｌｏｓｅｌｙ ｒｅｌａｔｅｄ ｗｉｔｈ ｇａｌｌｂｌａｄｄｅｒ ｓｔｏｎｅｓ．
【Abstract】ObjectiveTo explore the relationship between anomalous pancreaticobiliary ductal junction(APBDJ) and gallbladder carcinoma. MethodsThe current related literatures were reviewed.ResultsAPBDJ was associated with gallbladder carcinoma development. A proposed mechanism was free reflux of pancreatic juice into the gallbladder and molecular alterations of gallbladder epithelial cells.ConclusionAPBDJ is a high risk factor for gallbladder carcinoma. Prophylactic cholecystectomy is recommended for patients with APBDJ.
We reviewed the clinical studies on drug therapy for gallbladder cancer and expounded on the current situation of conversion therapy for gallbladder cancer. Gallbladder cancer was usually diagnosed late, with high malignancy, low surgical resection rate, and poor prognosis. With the development of conversion therapy, systemic therapy combined with radical resection had effectively improved the surgical resection rate and prognosis of gallbladder cancer patients. At present, most of the published conversion therapies for gallbladder cancer were mainly retrospective researches, lacking large multicenter prospective research, and the treatment plan was still based on chemotherapy, lacking the research of targeted therapy in combination with immunotherapy. It is expected that more high-quality clinical trials can be made first-line recommendations for the conversion therapy of gallbladder cancer.
目的:探讨MRI及多层螺旋CT多平面重建显示胆囊癌对邻近结构侵犯的价值。方法:前瞻性分析18例(CT及MRI各9例)胆囊癌对邻近结构侵犯情况。CT及MRI均包括平扫及增强扫描,CT扫描病例除横断断位外,行冠状位、矢状位重建;MRI病例行横断位、冠状位及矢状位扫描。结果:胆囊癌对邻近结构侵犯的敏感度、特异度、准确度如下:①横断位和矢状位显示邻近肝实质侵犯分别为81.2％、100.0％、83.3％,冠状位分别为87.5％、100.0％、88.9％;②横断位显示胃窦侵犯分别为75.0％、90.0％、83.3％,冠状位及矢状位均分别为75.0％、80.0％、77.7％;③横断位显示十二指肠侵犯分别为70.0％、75.0％、72.2％,冠状位分别为80.0％、75.0％、77.7％,矢状位分别为70.0％、75.0％、72.5％;④横断位和冠状位显示结肠肝曲侵犯均分别为25.0％、85.7％、72.2％,矢状位分别为50.0％、71.4％、66.6％;⑤横断位和冠状位显示胆管侵犯均分别为75.0％、100.0％、83.3％,矢状位分别为66.6％、100.0％、77.7％;⑥横断位、冠状位及矢状位显示邻近腹膜侵犯及淋巴结转移准确度均为66.6％;显示网膜侵犯准确度均为50.0％。结论:横断位、冠状位及矢状位显示胆囊癌对邻近肝实质、胃、十二指肠、胆管侵犯的敏感度、特异度、准确度较高;而显示对结肠肝曲、腹膜、网膜侵犯的准确度较低。
ObjectiveTo investigate the effect of combined or non-combined liver resection for T2a gallbladder cancer. MethodsAccording to the established inclusion and exclusion criteria, the patients with T2a gallbladder cancer admitted to Peking Union Medical College Hospital from January 2016 to December 2021 were retrospectively collected, then were assigned into combined with liver resection group and non-combined with liver resection group. The general characteristics, perioperative information, and prognosis of the two groups were compared. ResultsA total of 58 patients were enrolled in this study, including 23 males and 35 females; aged (64.8±11.1) years. There were 43 cases in the combined with liver resection group and 15 cases in the non-combined with liver resection group. There were no statistic differences in the demographic data, lifestyle, onset symptoms, preoperative combined diseases, and preoperative tumor markers between the two groups (P>0.05). Compared with the combined with liver resection group, the proportion of patients received bile duct resection was higher (P=0.013) and the operation time was shorter (P=0.045) in the non-combined with liver resection group. There were no statistic differences in the other perioperative informations between the two groups (P>0.05). A total of 12 patients had postoperative complications, including 3 cases of grade Ⅰ, 8 cases of grade Ⅱ, and 1 case of grade Ⅲa by Clavien-Dindo classification. All patients improved after treatment and were discharged smoothly. No patient was readmitted within 30 d after discharge. All 58 patients were followed up with a median follow up time of 29 months. During the follow-up period, there were 47 cases (81.0%) of tumor-free survival, 2 cases (3.4%) of survival with tumor, and 9 cases (15.5%) of death. There were no statistic differences in the overall survival and disease-free survival between the two groups by log-rank test (χ2=3.418, P=0.064; χ2=1.543, P=0.214). ConclusionFromthe results of this study, for T2a gallbladder cancer, liver resection would not result in increased complications or longer hospital stay, but don’t obviously improve prognosis.