Adjuvant chemoradiation in resected gallbladder cancer: a prognostic index model for predicting overall survival

Abstract

Patients with gallbladder cancer (GBC) have a dismal prognosis. We investigated outcomes and risk factors for overall survival (OS) in patients treated with radical surgery and adjuvant chemoradiotherapy (CRT). A total of 212 patients with LAGC (⩾pT3 59% and/or pN+ 52%) were studied. The primary endpoint of the analysis was OS. We constructed a risk scoring system in which points were assigned to each risk factor by dividing each β coefficient in the final model by the lowest β coefficient and rounding to the nearest integer. A risk score was assigned to each subject by adding up the points for each risk factor present. Subjects were then divided into three risk groups based on their risk scores (0 points = low risk, 1–2 points = intermediate risk, 3–6 points = high risk). Median follow-up was 46.2 months (2–235). Five-year OS for the entire cohort was 53%. In multivariate analysis, higher pT stage [HR, 2.43 (1.29–3.68); p = 0.01], R1 resection [HR, 5.06 (3.12–8.19); p < 0.001], and number of surgical procedures [HR, 1.41 (1.01–2.16); p = 0.05] were associated with an increased risk of death. Five-year OS for patients with low (n = 63), intermediate (n = 94), and high (n = 55) risk was 79.1%, 51.2%, and 9.5%, respectively. Overall results after multimodality treatment of GBC are promising. A risk model was generated to determine a prognostic index for individual patients with GBC. Classification of risk factors for death has contributed to propose a prognostic index that could allow us to guide risk-adapted tailored treatment.