Prognostic heterogeneity of the seventh edition of UICC Stage III gallbladder carcinoma: Which patients benefit from surgical resection?

BACKGROUND: This study sought to evaluate the prognostic heterogeneity of Stage III (Union for International Cancer Control, seventh edition) gallbladder carcinoma. METHODS: Of 175 patients enrolled with gallbladder carcinoma who underwent radical resection, 22 were classified with Stage IIIA disease (T3N0M0) and 46 with Stage IIIB disease (T2N1M0 [n = 23] and T3N1M0 [n = 23]). The median number of retrieved lymph nodes per patient was 18. RESULTS: This staging system failed to stratify outcomes between Stages IIIA and IIIB; survival after resection was better for patients with Stage IIIB disease than for patients with Stage IIIA disease, with 5-year survival of 54.9% and 41.0%, respectively (p = 0.366). Multivariate analysis for patients with Stage III disease revealed independently better survival for patients with T2N1M0 than for patients with T3N0M0 (p = 0.016) or T3N1M0 (p = 0.001), with 5-year survival of 77.0%, 41.0%, and 31.0%, respectively. When N1 status was subdivided according to the number of positive nodes, 5-year survival in patients with T2M0 with 1-2 positive nodes, T2M0 with ≥3 positive nodes, T3M0 with 1-2 positive nodes, and T3M0 with ≥3 positive nodes was 83.3%, 50.0%, 45.8%, and 0%, respectively (p < 0.001). CONCLUSIONS: The prognosis of T2N1M0 disease was better than that of T3N0/1M0 disease, suggesting that not all node-positive patients will have uniformly poor outcomes after resection of gallbladder carcinoma. T2M0 with 1-2 positive nodes leads to a favorable outcome after resection, whereas T3M0 with ≥3 positive nodes indicates a dismal prognosis.

Serial change of sliding in intertrochanteric femoral fractures treated with sliding screw system.

We investigated the serial change of the extent of sliding of the compression screw in 42 intertrochanteric femoral fractures fixed with a sliding screw system. Neither age, gender, bone density, fracture type nor quality of fracture reduction could accurately predict healing time. There was a significant correlation between the extent of sliding at union and healing time (correlation coefficient r = 0.505). The average healing time in group B (the extent of sliding at union of 8 mm or greater) was 13.8 weeks postoperatively, and that in group A (the extent of sliding at union of less than 8 mm) was 8.9 weeks. There was a significant difference in the average healing time between groups A and B (P = 0.0004). The extent of sliding at union had a influence on the healing time. The phenomenon of sliding progressed mainly during the first 2 weeks postoperatively. There was a significant positive correlation between the extent of sliding at union and the extent of sliding at 2 weeks postoperatively (r = 0.977). An assessment using the extent of sliding at 2 weeks postoperatively can accurately predict the extent of sliding at union and the healing time. It is important to examine the phenomenon of sliding during the early postoperative course, especially until 2 weeks postoperatively, in order to predict fracture repair.