Epidemiology, treatment outcome, and survival of primary gallbladder cancer in the United States: A period prevalence SEER database study 1973-2007.

Abstract

4104 Background: Primary gallbladder cancer (GBC) is an aggressive, uncommon with dismal outcomes. There has been no systemic analysis of epidemiology, outcome and survival of GBC in the past. This is the first study to examine these aspects of GBC diagnosed in last four decades (1973-2007) in USA. Methods: Frequency sessions on demographic and treatment were performed and compared among Caucasian (USW), Hispanic, African-American (AA) and Asian. Multivariate analysis and survival sessions (Kaplan-Meier, age adjusted) were performed using SEER database from 1973-2007. Results: Total of 12,993 GBC were reported in SEER from 1973-2007. It is more common in female (73% vs. 27%, p <0.0001) with incidence rate of 2 per million. Average age of diagnosis is 64 yrs but women were younger at diagnosis (59 vs. 69 years, p < 0.0001). 73% of GBC were diagnosed at advance stages. Among female USW, 39% were diagnosed at age less than 50. This is a distinctive trend and unique to GBC. Fewer USW received surgery and radiation (p < 0.01) than other groups indicating advance diseases. Differencesamong all ethnic groups in likelihood of receiving surgery, radiation andchemotherapy remained significant afteradjustment for stages, age, and year of diagnosis. Comparable 1 yr survival (28%) in different groups was observed. But 2-5 yrs survival is significantly higher in Asian (24%-17%) and Hispanics (24%-18%) than USW (19%-13%) and AA (19%-11%) (p= 0.02-0.05). Survival improvedconsiderably over time in all groups but more in Asian than others. Cox regression analysis showed that age at diagnosis, stage, marital status, and yearof diagnosis were predictors of death. Relative risk of death increased with higher stages and older ages. Chemotherapy and radiation were statisticallyassociated with poorer survival and higher RR.Persons, who did not receive surgery, had significantly worse survival and higher RR. Conclusions: GBC is rare but more common in female. 73% of the GBC were diagnosed at advance stages. More USW female were diagnosed at age younger than 50. Survival improvedconsiderably over time but remains poor. More studies are warranted to examine these epidemiological and survival trends.