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.
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 investigate the long-term efficacy of laparoscopic cholecystectomy (LC) for gallbladder cancer.MethodThe clinical data of 52 patients with gallbladder cancer only underwent LC from January 1998 to December 2018 in the Peking Union Medical College Hospital were analyzed retrospectively.ResultsFifty-two patients met the inclusion criteria were included, including 23 males and 29 females. The age was (67±12) years. Fifty-two patients were treated with LC because of gallbladder occupying or gallstone. Twenty-three patients were diagnosed as incidental gallbladder cancer after the surgery, while 29 patients were diagnosed as the gallbladder cancer before or during the operation. Eleven patients with T1a lesions received the close follow-up, the other 41 patients refused the radical operation due to the advanced age, severe underlying diseases or their own preferences. Five cases of postoperative complications were observed. All patients were followed-up for (40.2±33.8) months, 21 patients survived and 31 died. The dead patients had an older age, longer hospital stays, and later T stage (P<0.050) as compared with the living patients. The patients with T1a lesions had significantly longer survival time than those with T1b and above (113.5 months versus 39.6 months, P<0.001).ConclusionsLC is a radical operation in T1a lesions. At the same time, it can meet the requirements of postoperative life quality for some special patients due to its safety and low postoperative complication rate.
ObjectiveTo evaluate feasibility of laparoscopic radical resection and re-resection for suspicious and incidental gallbladder cancer.MethodsWe searched PubMed and other databases, reviewed relevant literatures and summarized from aspects like whether efficacy comparable to laparotomy and enough lymph node dissection could be achieved through laparoscopy, timing of reoperation for incidental gallbladder cancer.ResultsLaparoscopic radical resection and re-resection were theoretically and technically feasible, but its efficacy and timing of re-resection were controversial, and its long-term efficacy needed further discussions in multi-center and large-scale cohort studies.ConclusionsLaparoscopy shows prospects of resection and re-resection for suspicious and incidental gallbladder cancer. Tentative explorations could be done in properly selected patients by well-experience medical centers and to achieve efficacy comparable to laparotomy is the fundamental principle.
Objective To assess the clinical efficacy and treatment-induced side effects of intravesically administered bacillus calmette-guerin (BCG) plus chemotherapy following TURB-t in patients with superficial bladder cancer compared with BCG alone.Methods Randomized controlled trials (RCTs) were identified from PubMed (1950 to December 2006), Ovid (1966 to December 2006), EMbase (1984 to December 2006), The Cochrane Library (Issue 4, 2006), CBM (1978 to 2006) and VIP (1989 to 2006). We also handsearched relevant published and unpublished reports as well as their references.The quality of included trials was evaluated by two reviewers. We used The Cochrane Collaboration’ s RevMan 4.2.9 software for statistical analysis. Results Four studies involving 681 patients were included. Meta-analyses showed that, in patients with Ta and T1 bladder cancer, there was a significant difference in the recurrence rate between intravesically administered BCG plus chemotherapy and BCG alone (RR 0.69, 95%CI 0.53 to 0.90). In patients with Tis bladder cancer, no significant difference was found in the recurrence rate between the two groups (RR 1.22, 95%CI 0.97 to 1.54). In patients with Ta, T1 and Tis bladder cancer, no statistically significant difference was found in the incidence of side effects (RR 0.85, 95%CI 0.70 to 1.03). Conclusion Compared with BCG alone, intravesically administered BCG plus chemotherapy in patients with Ta and T1 superficial bladder cancer can reduce the incidence of tumor recurrence more effectively. For patients with Tis bladder cancer, the two therapeutic regimens do not differ in the incidence of tumor recurrence. The two regimens have similar side effects. There is a moderate possibil ity of selection bias, performance bias and publ ication bias in the small number of included studies, which weakens the strength of the evidence of our results. Better evidence from more high-quality double-blind randomized controlled trials is needed.
Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with transurethral resection of bladder tumor (TURBT) for muscle-invasive bladder cancer (MIBC). Methods China National Knowledge Infrastructure, Chongqing VIP, Wanfang, SinoMed, PubMed, Web of Science, and Cochrane Library were searched from the establishment of databases until December 2023. All randomized controlled trials of TACE combined with TURBT for MIBC were collected and subjected to meta-analysis using RevMan 5.4 software. Results A total of 7 studies were included, involving 490 patients, with 246 in the TACE+TURBT group and 244 in the TURBT group. The meta-analysis results showed that compared with TURBT, TACE+TURBT had certain advantages in reducing recurrence rate [relative risk (RR)=0.49, 95% confidence interval (CI) (0.35, 0.68)], improving survival rate [RR=1.16, 95%CI (1.07, 1.27)], shortening surgical time [standardized mean difference (SMD)=−4.97, 95%CI (−7.54, −2.40)], reducing intraoperative bleeding [SMD=−4.19, 95%CI (−5.78, −2.60)], and improving quality of life [SMD=4.51, 95%CI (2.15, 6.86)]. The adverse reactions of the two groups were similar. Conclusions Existing evidence suggests that TACE may reduce intraoperative bleeding and shorten surgical time to help achieve maximum TURBT. TACE combined with TURBT may be superior to simple TURBT in terms of tumor recurrence rate and survival rate. TACE combined with TURBT can benefit MIBC patients in bladder-preserving treatment plans.
The morbidity and mortality of gallbladder cancer were rising. At present, there was no effective chemotherapy regimen, so it was of great practical significance to explore new therapy target. Ferroptosis is a non-apoptotic form of cell death characterized by iron-dependent lipid peroxidation and metabolic constraints. In recent years, it had become a research hotspot. Many studies had been carried out on the relevant biological mechanisms such as liver cancer, breast cancer, pancreatic cancer, and other cancer. At present, there are still few studies on ferroptosis in gallbladder cancer, and its relevant mechanisms need further in-depth analysis, which opens up a new research direction for exploring the treatment of gallbladder cancer.
ObjectiveTo analyze the epidemiological characteristics and trends of gallbladder cancer incidence and mortality in Zhejiang cancer registration areas from 2000 to 2021, providing a basis for formulating prevention and control strategies for gallbladder cancer. MethodsData on incidence and mortality were collected from 22 cancer registry areas in Zhejiang Province from 2000 to 2021, calculating the crude incidence (mortality), age-standardized incidence / mortality rate by Chinese standard population(ASR China), age-standardized incidence /mortality rate by World standard population (ASR World) and cumulative rate (0–74 years old). The average annual percentage change (AAPC) was calculated by using Joinpoint software. ResultsIn 2021, the crude incidence of gallbladder cancer in Zhejiang cancer registration areas was 6.79 per 100 000. The ASR China and ASR World were 2.99 and 2.96 per 100 000, respectively, ranking 18th of all new cancer cases. The incidence ASR China in female (3.13 per 100 000) was higher than that in male (2.85 per 100 000). The incidence ASR China in rural areas (3.01 per 100 000) was slightly higher than that in urban areas (2.97 per 100 000). The crude mortality of gallbladder cancer was 5.14 per 100 000, with the mortality ASR China and ASR World of 2.09 and 2.10 per 100 000, respectively, ranking 10th of all new cancer deaths. The mortality ASR China in female (2.19 per 100 000) was higher than that in male (1.98 per 100 000). The mortality ASR China in urban areas (2.11 per 100 000) was slightly higher than that in rural areas (2.07 per 100 000). Both the crude incidence and mortality of gallbladder cancer increased with age. The crude incidence and mortality showed an upward trend over time, with AAPC of 2.59% and 3.75%, respectively (P<0.001). The incidence ASR China did not show significant changes over time (AAPC=0.05%, P=0.856). The incidence ASR China in male and rural areas showed increasing trends over time, with AAPCs of 0.89% (P=0.016) and 1.14% (P=0.001), respectively. The incidence ASR China in female and urban areas showed no significant trends over time, with AAPCs of –0.26% (P=0.503) and –0.02% (P=0.967), respectively. The mortality showed a slower upward trend after adjusting the age structure (AAPC=1.01%, P=0.020). ConclusionsThe elderly population in rural areas, especially elderly women, are the primary targets for the prevention and control of gallbladder cancer. Aging is the main factor contributing to the increase in the incidence and mortality of gallbladder cancer. After adjusting for demographic factors, the overall upward trend of the incidence in the male population and rural areas, as well as mortality, cannot be ignored.
ObjectiveTo summarize the research progress of long non-coding RNA (lncRNA) in the regulation of malignant biological behavior of gallbladder cancer so as to provide references for its related research.MethodThe relevant literatures about studies of lncRNA in gallbladder cancer in recent years were reviewed.ResultsThe recent studies had shown that 19 lncRNAs associated with gallbladder cancer had played the important roles in regulating tumor cell proliferation, migration, invasion, apoptosis, “sponge” miRNAs, chemoresistance, and tumor metastasis. Among them, most lncRNAs tended to have carcinogenic properties, only a few had anticarcinogenic effect. Although the research suggested the mechanism and role of lncRNA to promote or inhibit the occurrence and development of gallbladder cancer, the current research on its mechanism was still limited. In addition, some lncRNAs were found to be specifically expressed in the serum of patients with gallbladder cancer, so which were expected to become biomarkers for tumor diagnosis and prognosis.ConclusionslncRNAs associated with gallbladder cancer have carcinogenic or anticarcinogenic effect, or chemoresistance. They play potential roles in diagnosis, prognosis, and (or) treatment of tumors, but molecular mechanisms of their effects are still limited.
Bladder cancer is the most common malignant tumor in the urinary system. The standard treatment of muscle-invasive bladder cancer (MIBC) is the radical cystectomy combined with pelvic lymphadenectomy. In recent years, radiotherapy has played an important role in the MIBC bladder-preserving treatment model. This article will review the advances in the application of radiotherapy for bladder preservation in MIBC, and introduce the application progress of radiotherapy in trimodality therapy of adjuvant radiotherapy and chemotherapy after transurethral resection of bladder tumors, radical radiotherapy, preoperative radiotherapy, radiotherapy combined with immunotherapy, the development and challenges of radiotherapy technology, and radiotherapy-related adverse reactions. The aim of this article is to provide a reference for further exploration of a more scientific and effective comprehensive treatment mode for bladder preservation.