Objective To enhance survival rate and treatment effect for advanced gallbladder cancer (GBC). MethodsEighty cases of advanced GBC were treated surgically from January 1990 to June 2001.Seventyone cases had obstructive jaundice, 15 had palpable abdominal mass. Extended radical cholecystectomy was performed in 39 cases of advanced GBC in which the tumor invaded the surrounding organs or tissues but without distant metastasis. ResultsFollowup showed that the survival period was between 8 and 37 months (average 18.1 months), 1， 2 and 3year survival rates were 43.6%， 20.5% and 5.1% respectively. Palliative operations were performed in other 41 advanced GBC cases with distant metastasis. All of the patients died within one year. Conclusion This result suggests that extended radical cholecystectomy is effective for advanced GBC.
Objective To investigate the relationship between microvessel density(MVD) and lymph node metastasis and prognosis in gallbladder carcinoma. MethodsThe MVD in 42 gallbladder carcinoma by immunohistochemical SP method using a polyclonal antibody to FⅧ and the relationship between MVD and histologic types, depth of invasion, lymph node metastasis, distant metastasis and prognosis was studied. Results The value of MVD was correlated with the depth of invasion (P＜0.05), lymph node metastasis (P＜0.01) and distant metastasis (P＜0.05). It was not significantly related to the pathologic pattern and tumor differentiation. The significantly negtive correlation was found between MVD and 5-year survival in patients with gallbladder carcinoma. Conclusion MVD is bly related to the metastasis of gallbladder carcinoma. It may serve as a prognotic factor.
ObjectiveTo study the effects of the expressions of endostatin, basic fibroblast growth factor (bFGF) and CD34 on oncogenesis and progression of gallbladder cancer, and to explore some valuable criterias for its biotherapy. Methods The expressions of endostatin, bFGF and CD34 were studied by means of immunohistochemistry (SP) in 61 cases of gallbladder cancer and 10 cases of normal cholecystic tissue, and microvessel density (MVD) was calculated by the expression of CD34. Their relationships with clinical pathological features were also investigated. Results The expression rates of endostatin in normal cholecystic tissue and in gallbladder cancer tissue were 40.00% (4/10) and 77.05% (47/61) respectively, which had statistical difference (P＜0.05). The expression of endostatin in 61 cases of caner was relational to clinical stage and metastasis of lymph nodes (P＜0.05), while no significant correlation was detected with sex and age of patient, location of tumor, size of tumor and histologic grade (P＞0.05). The expression rates of bFGF in normal cholecystic tissue and in gallbladder cancer tissue were 20.00%（2/10） and 67.21% （41/61） respectively, which had statistical difference (P＜0.05). The expression of bFGF in 61 cases of caner was relational to clinical stage and metastasis of lymph nodes (P＜0.05), while no significant correlation was detected with sex and age of patient, location of tumor, size of tumor and histologic grade (P＞0.05). MVD in gallbladder cancer tissue and in normal cholecystic tissue was （76.66±20.15） piece/HP and (29.53±5.03) piece/HP respectively, showing significant difference (P＜0.01). In 61 cases of cancer, MVD in clinical stage Ⅲ～Ⅴ 〔(80.53±17.98) piece/HP〕 was much higher than that in stage Ⅰ+Ⅱ 〔(46.79±5.38) piece/HP〕, P＜0.01; MVD was higher in those with lymph nodes metastasis 〔(94.60±7.28) piece/HP〕 than those without metastasis 〔(58.12±9.24) piece/HP〕, P＜0.01; and MVD was (60.59±14.71) piece/HP in histologic grade G1， (83.08±15.30) piece/HP in G2， and (96.53±6.92) piece/HP in G3, the difference was significant among them （P＜0.01）. There was no significant correlation between MVD and sex and age of patient, location of tumor and size of tumor (P＞0.05). There were statistically significant correlations between expressions of endostatin and MVD （P＜0.01）, expressions of bFGF and MVD （P＜0.01）. Conclusions The result suggests that endostatin, bFGF and CD34 play roles in oncogenesis and progression of gallbladder cancer. Detection of these proteins has positive effects on diagnosis, malignant degree determination and treatment of gallbladder cancer.
Objective To study the feasibility of radical resection of gallbladder cancer with extensive invasion. Methods A patient of the gallbladder cancer with invasion of liver, gastric antrum, duodenum, caput pancreatis and colon transversum, was received radical resection (including pancreatoduodenectomy, hepatectomy and colectomy). Results Seven months later, the value of CEA and Hb were normal and cancer recurrence was not observed. Conclusion The radical resection of gallbladder cancer with extensive invasion, can improve survival quality and extent survival time.
ObjectiveTo study the mechanism of invasion of CD133 positive population in gallbladder cancer. MethodsThe invasive abilities of the CD133 positive cells and the CD133 negative cells were detected by Transwell.The CXCR4 mRNA and protein in the CD133 positive cells and the CD133 negative cells were detected by the semi-quanti-tative RT-PCR, Western blot method, and immunofluorescence, respectively.SDF-1αand AMD3100 were respectively used to stimulate/inhibit the GBC-SD cells.The invasive ability and the migration force were detected in the CD133 posi-tive cells and the CD133 negative cells.The expressions CD133 mRNA and protein of the GBC-SD cells were detected by semi-quantitative RT-PCR and Western blot method, respectively. Results①The number of invasion cells in the CD133 positive cells was significantly more than that in the CD133 negative cells (23.78±8.74 versus 6.56±3.09, P=0.000 7).②The fluorescent protein of CXCR4 in the CD133 positive cells was stronger than that in the CD133 negative cells.The expression of CXCR4 mRNA in the CD133 positive cells was significantly higher than that in the CD133 negative cells (0.642 4±0.020 4 versus 0.335 9±0.043 2, P=0.004).The expression of CXCR4 protein in the CD133 positive cells was significantly higher than that in the CD133 negative cells (0.765 0±0.106 6 versus 0.409 4±0.019 5, P=0.013).③In the CD133 positive cells, compared with the control group, the number of invasion cells was significantly increased in the SDF-1αgroup (62.89±15.27 versus 23.78±8.74, P=0.000 6) and decreased in the AMD3100 group (10.33±2.00 versus 23.78±8.74, P=0.000 2).In the CD133 negative cells, compared with the control group, the number of invasion cells was not significant change in the SDF-1αgroup (6.89±4.23 versus 6.59±3.09, P=0.41) and in the AMD3100 group (6.11±2.67 versus 6.59±3.09, P=0.38), respectively.④In the CD133 positive cells, compared with the control group, the number of migration cells was significantly increased in the SDF-1αgroup (74.56±15.80 versus 35.56±10.97, P=0.000 3) and decreased in the AMD3100 group (12.67±2.40 versus 35.56±10.97, P=0.000 2).In the CD133 negative cells, compared with the control group, the number of migration cells was not significant change in the SDF-1αgroup (9.78±2.04 versus 9.56±1.74, P=0.43) and in the AMD3100 group (9.54±1.74 versus 9.56±1.74, P=0.42).⑤In the GBC-SD cells, compared with the control group, the CD133 mRNA was significantly increased in the SDF-1αgroup (0.626 5±0.048 7 versus 0.450 0±0.024 3, P=0.004) and decreased in the AMD3100 group (0.359 3±0.047 3 versus 0.450 0±0.024 3, P=0.011);the CD133 protein was significantly increased in the SDF-1αgroup (0.508 9±0.020 7 versus 0.440 9±0.013 0, P=0.016) and decreased in the AMD3100 group (0.317 7±0.013 7 versus 0.440 9±0.013 0, P=0.004). ConclusionThe high invasion ability of CD133 positive population in gallbladder cancer might be due to the high expression of CXCR4.
ObjectiveTo investigate clinical value of magnetic resonance imaging (MRI) in differentiating xanthogranulomatous cholecystitis (XGC) with gallbladder cancer (GBC). MethodsMRI data of 7 patients with XGC and 13 patients with GBC proved by surgery and pathology were analyzed retrospectively. The main contents of the observation included:①Maximum thickness of gallbladder wall; ②Diffuse thickening or localized thickening of gallbladder wall; ③Enhancement pattern (uniform or nonuniform) of gallbladder wall; ④Gallbladder wall sandwiches enhancement; ⑤Gallbladder wall nodules; ⑥Completeness of gallbladder mucosa lines; ⑦Obstruction of biliary tract; ⑧Calculus in gallbladder or bile duct; ⑨Involvement of adjacent liver; ⑩Definition of surrounding fat layer; Lymphadenopathy. ResultsIn above 11 MRI comparing features, these features such as the gallbladder wall sandwiches enhancement, the gallbladder wall nodules, the completeness of gallbladder mucosa lines, the biliary obstruction, and the lymphadenopathy were statistically significant between the XGC and the GBC (P < 0.05), while the rest features such as the maximum thickness of gallbladder wall, the type of gallbladder wall thickening, the gallbladder wall enhancement pattern, the calculus in gallbladder or bile duct, the involvement of adjacent liver, and the definition of surrounding fat layer were not statistically significant between the XGC and the GBC (P > 0.05). ConclusionMRI has important values in differentiating XGC with GBC.