Rokitansky Aschoff Sinus Involvement in Early Gallbladder Carcinoma (EGBC) as a Prognostic Factor: A Concurrent Cohort Study of 190 EGBC.
Juan Carlos S Roa, Oscar E Tapia, Carlos D Manterola, Miguel H Villaseca, Pablo Guzman, Juan Carlos O Araya, NVolkan Adsay. Universidad de La Frontera, Temuco, Chile; Emory University, Atlanta, GA
Background: Studies from high-incidence regions including Chile have shown that early gallbladder cancers (EGBC), i.e., carcinomas confined to the muscularis, including frank CIS, intramucosal adenocarcinoma (IMA) and those that expand/replace the mucosa to abut and push into the muscularis (MP) have a very good prognosis with 10-year survival approaching 90%. Factors associated with recurrence and metastases in this group have yet to be determined.
Design: 190 EGBCs (identified in a database of 953 GBCs), which have been processed with a uniform approach (sampled entirely, and mapped according to a previously established protocol) were analyzed.
Results: F/M=157/33. Mean age=58 (vs 65 in advanced GBC, confirming the continuum). Most were inapparent clinically, and some also macroscopically (60%). In a median follow up of 144 months, the actuarial survival was 92 % at 5-year and 90% at 10-year. There was no significant survival difference between non-complex IMA (n=78) vs complex IMA (n=31) vs MP cases (n=81; p=0.4). The prognosis of well differentiated/gland-forming EGBCs (n=128) was better than that of the moderate and poorly differentiated (n=62; p=0.026). The extent of carcinoma [diffuse (>75% of the entire GB mucosa; n=72) vs substantial (25-75%; n=101) vs focal (<25%; n=17)] was not significant (p=0.3). Extension to RAS was identified in 34 cases; rare (<3 RAS foci) in 5 and substantial (>3 RAS foci) in 29, and was deep extending to the level of muscle in 19 and level of subserosa in 15. The presence of RAS involvement had significant correlation with adverse outcome (p=9,7X10-8) with an odds-ratio of 7.3 (CI 95% 3-17). The disease related mortality in these RAS+ cases occurred late (median, 48 mos), and thus was not attributable to missed foci of invasion. When the RAS+ cases were eliminated from the survival analysis, the survival at 10-year increased from 92% to 100% for IMA and 88% to 93% for MP.
Conclusions: EGBC exhibits variable histologic patterns, grade and extent. While EGBC has a very good overall prognosis, with a 10-year survival of 90%, those patients with RAS involvement are much more likely to die of disease, highlighting the importance of thorough examination of these cases and the proper documentation of this finding. We propose that in patients with EGBC and RAS involvement, additional radical surgery, or at minimum, close long-term surveillance is warranted.
Financed by DIUFRO and Fondecyt Grant 1090171.
Category: Liver & Pancreas
Tuesday, March 1, 2011 2:30 PM
Platform Session: Section C, Tuesday Afternoon