A largescale multicenter retrospective study of current surgical treatment modalities and pathological characteristics of patients with gallbladder cancer in China: a report of 4,345 cases        SUN Xu-heng*, REN Tai, GENG Ya-jun, et al. *Department of Pancreatobiliary Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200127, China；Shanghai Cancer Institute, State Key Laboratory for Oncogenes and Related Genes, Shanghai 200127, China
Corresponding author: LIU Ying-bin, E-mail:laoniulyb@163.com
Abstract    Objective    To investigate the current status of surgical treatment, pathological characteristics and prognosis of patients with gallbladder cancer in China. Methods    The data of 4,345 patients with gallbladder cancer admitted to 26 hospitals in 13 provinces and cities in China from January 2010 to December 2017 were retrospectively collected. The regional, gender, and age distribution of gallbladder cancer patients in China were summarized and analyzed. Based on medical records and examination results of patients, we evaluated the resectability of tumors in patients treated by surgery, summarized and analyzed the surgical treatment modalities of patients with resectable tumors, and evaluated resectable tumor surgery with reference to the results of preoperative examinations, surgical records and postoperative pathological examinations to estimate whether the treatment meets the standard of radical resection. Results    Among the 4,345 patients with gallbladder cancer included in this study, males accounted for 1,664 (38.23%) and females accounted for 2,681 (61.77%). 3,129 (71.01%) patients underwent surgical treatment, including 2,074 (66.28%) patients with resectable tumors, and only 1,133 (54.63%) patients with resectable tumors were diagnosed as gallbladder malignancies before surgery. 1,002 cases (48.31%) of resectable tumors underwent radical resection, and 1072 (51.69%) cases did not meet the criteria for radical resection. According to the pathological results of patients with radical resection of gallbladder cancer, 736 cases (73.45%) were adenocarcinoma, 348 cases (34.73%) were poorly differentiated, 376 cases (37.52%) had liver invasion, and 152 cases (15.17%) had nerve infiltration, 96 cases (9.58%) had intravascular tumor thrombi, 78 cases (7.78%) had peripheral fatty tissue infiltration, 89 cases (8.88%) had peripheral organ involvement, and 328 cases (32.73%) had positive results of lymph node biopsy. The postoperative median survival time of 2,357 surgically treated patients with survival follow-up data was 16.17 months. The results of multivariate Cox regression survival analysis showed TNM staging(P<0.001), tumor differentiation (P<0.001), liver invasion (P<0.001), R0 resection (P=0.003) are independent prognostic factors for overall survival after surgery. Conclusions    The preoperative diagnosis rate of gallbladder cancer in China needs to be improved and the surgical treatment modalities of gallbladder cancer needs to be standardized; multiple factors reported in pathological files are closely related to the prognosis of patients with gallbladder cancer, the standardization of pathological description may be of great significance in guiding the precise treatment of patients with gallbladder cancer.