Abstract
BackgroundThe benefit of adjuvant therapy (AT) for gallbladder cancer (GBC) is unclear as evidenced by conflicting results from nonrandomized studies. Here we aimed to perform a meta-analysis to determine the impact of AT on overall survival (OS).MethodsWe used data from MEDLINE, EMBASE and the Cochrane Collaboration Library and published between October 1967 and October 2014. Studies that evaluated AT compared with curative-intent surgery alone for resected GBC were included. Subgroup analyses of benefit based on node status, margins status, and American Joint Committee on Cancer (AJCC) staging were prespecified. Data were weighted and pooled using random-effect modeling.ResultsTen retrospective studies involving 3,191 patients were analyzed. There was a nonsignificant improvement in OS with AT compared with surgery alone (hazard ratio [HR], 0.76; 95 % confidence interval [CI], 0.56–1.03). A significant improvement was observed in OS with chemotherapy (CT) compared with surgery alone (HR, 0.42; 95 % CI, 0.22–0.80) by sensitivity analysis. The greatest benefit for AT was also observed in those with R1 disease (HR, 0.33; 95 % CI, 0.19–0.59), LN-positive disease (HR, 0.71; 95 % CI, 0.63–0.81), and AJCC staging meeting or exceeding tumor Stage II (HR, 0.45; 95 % CI, 0.26–0.79), but not in those with LN-negative or R0 disease.ConclusionOur results strongly support the use of CT as an AT in GBC. Moreover, patients with node positivity, margin positivity, or non-stage I disease are more likely to benefit from AT.
Highlights
The benefit of adjuvant therapy (AT) for gallbladder cancer (GBC) is unclear as evidenced by conflicting results from nonrandomized studies
Random effect model was applied and as a result, pooled data showed a nonsignificant improvement in overall survival (OS) with any AT compared with surgery alone (HR, 0.76; 95 % confidence interval (CI), 0.56–1.03; Fig. 2a) in the overall population
We found that patients with GBC and R0 resection could not benefit from AT compared with surgery alone (HROS, 1.29; 95 % CI, 0.91–1.84; Fig. 3a)
Summary
The benefit of adjuvant therapy (AT) for gallbladder cancer (GBC) is unclear as evidenced by conflicting results from nonrandomized studies. We aimed to perform a meta-analysis to determine the impact of AT on overall survival (OS). Gallbladder cancer (GBC) is an uncommon but the most aggressive biliary tree cancer (BTC). GBC is the sixth most common gastrointestinal cancer with an annual incidence rate of 2.2 per 100,000 [1, 2]. Only 10 % of patients who present with early-stage GBC are considered surgical candidates. A recent study by Valle J et al showed that longer overall survival (OS) with gemcitabine in combination with cisplatin than with gemcitabine alone in patients with advanced or metastatic BTC [4]. Established adjuvant treatments (AT) for GBC are lacking and
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