Correlation Between Clinicopathological Characteristics And Prognosis Of Gallbladder Cancer

Part 1. Prognostic factors of 102 patients with gallbladder cancer (GBC) in a single centerObjective To investigate the prognostic risk factors in 102 cases of GBC and to further explore the role of radical surgery in late stage GBC.Methods A retrospective analysis of 102 patients with GBC underwent surgery at the department of General Surgery in ZhongShan hospital, Fudan University.23 clinicopathologic variables were chosen for univariate and multivariate analysis.Results 1-,2-,3-,5-year overall survival rates were 48%,43%,40%,38%, The median survival time was 22.5 months. Univariate analysis showed that CA199 abnormal (> 37U/ml), preoperative jaundice (TG>34.2umol/l), poorly differentiated tissue, extrahepatic bile duct invasion (pEBl), lymph node metastasis, TNM stage (Ⅲ and Ⅳ) and non-radical resection were factors of poor prognosis. Multivariate analysis showed that pEBI and non-curative resection were independent prognostic factors. No significant difference in survival between R0 and non-R0 resection of patients with pEBI (P=0.394) or stage IVA (P=0.200); The prognosis of patients with stage IVB underwent R0 resection were significantly better than those underwent non-RO resection (P=0.011); The prognosis of patients with liver metastasis underwent R0 resection were significantly better than those underwent non-RO resection (P=0.010).Conclusion Univariate analysis showed that CA199 abnormal, preoperative jaundice, poorly differentiated tissue, pEBI, lymph node metastasis, stage (Ⅲ and Ⅳ) and non-radical resection were factors of poor prognosis; Multivariate analysis showed that pEBI and non-curative resection were independent prognostic factors. Radical surgery can’t significantly improve the prognosis of patients with pEBI, however radical surgery can significantly improve the prognosis of patients with liver metastasis.Part 2. Correlation betwween tumor infiltrating Foxp3+,IL17+,CD8+lymphocy and prognosis of gallbladder cancer(GBC) Objective To investigate the correlation between tumor infiltrating Foxp3+, IL17+, CD8+lymphocytes and clinicopathological characteristics and prognosis of GBC.Methods Expression and density of tumor infiltrating Foxp3+, IL17+, CD8+ lymphocytes were assessed by immunohistochemistry in specimens containing tumor and peritumoral gallbladder tissue from 63 patients who had undergone resection for histologically proven GBC.Results High intratumoral Foxp3+ lymphocytes (Foxp3+T) density correlated with poorly differentiated tissue (P=0.041) and decreased overall survival (P=0.032), High peritumoral Foxp3+T density correlated with perineural invasion (P<0.001), pT3/pT4 (P=0.018) and stage Ⅲ/Ⅳ (P=0.048); Low intratumoral IL17+ lymphocytes (IL17+T) density correlated with stage III/IV (P=0.030), Low peritumoral IL17+T density correlated with extrahepatic bile duct invasion (P=0.017), pT3/pT4 (P=0.048) and decreased overall survival (P=0.045); High intratumoral CD8+ lymphocytes (CD8+T) density correlated with perineural invasion (P=0.044) and stage III/IV (P=0.023). High ratio of CD8+T/Foxp3+T correlated with increased overall survival (P=0.031).Conclusion Foxp3+T, IL17+T and ratio of CD8+T/Foxp3+T were significantly associated with the prognosis of GBC. Therefore, it may be a novel immunotherapy for GBC to decrease the intratumoral density of Foxp3+T while increasing the intratumoral density of CD8T.