Gallbladder Carcinoma in Portugal: A Single Center Experience and Prognostic Factors for Survival

Abstract

Purpose: To identify clinicopathological prognostic factors for survival in patients with gallbladder carcinoma (GBC) submitted to surgery in our institution–a tertiary centre. Methods: 41 patients underwent surgical treatment for GBC between 2008-2019. 26(63.4%) were female, 28(68.3%) had associated cholelithiasis and the majority of tumours, 35(85.4%), were adenocarcinomas. 41.5% were diagnosed incidentally, 65.9% had symptoms and 26.8% presented with acute cholecystitis. 46.3% were stage III (AJCC) or higher. 39% were submitted to cholecystectomy alone and 61% were also submitted to hepatic resection. 46.3% had vascular invasion, 26.8% hepatic parenchyma invasion and 9.8% bile duct invasion. Survival analysis was conducted on SPSS. Our institution ethics committee approved this work. Results: Median overall survival (OS) was 20.5 months (IQR 8.8-53.8). 3-year and 5-year survival rates were of 43.2% and 39.6%, respectively. On immunohistochemistry analysis, 6 patients (14.6%) were HER2+, but the HER2 status didn't show influence on OS (median OS 18 vs 20 months, p=0.649); all had microsatellite stability. There was no association between HER2 expression and staging (p=0.35). On univariate regression, the following factors were associated with worse OS: acute cholecystitis(HR 2.59 (95%CI 1.11-6.06), p=0.028), jaundice(HR 3.18 (95%CI 1.37-7.334), p=0.007), other carcinomas (HR 3.32 (95%CI 1.19-9.23), p=0.022), stage ≥ III(HR 10.35 (95%CI 2.34-45.75), p=0.002), N+(HR 6.55 (95%CI 2.38-18.03), p<0.001), vascular invasion(HR 8.96 (95%CI 2.78-28.89), p<0.001), hepatic invasion(HR 6.86 (95%CI 2.51-18.75), p<0.001), bile duct invasion(HR 3.50 (95%CI 1.11-11.02), p=0.033), ≥R1 resection(HR 11.79 (95%CI 3.8-36.6), p<0.001), CA 19.9 ≥500 U/mL(HR 2.5 (95%CI 1.05-5.98), p=0.039), CEA ≥5 ng/mL(HR 2.99 (95%CI 1.10-8.14), p=0.032); hepatic resection was associated with better OS(HR 0.24 (95%CI 0.11-0.67), p<0.001). On multivariate regression, stage ≥ III(HR 8.58, (95%CI 1.786-41.171), p=0.007), hepatic resection(HR 0.288, (95%CI 0.091-0.910), p=0.034) and vascular invasion(HR 4.06, (95%CI 1.035-15.918), p=0.045) were independently associated with OS. Conclusions: This study on GBC is, as far as the authors know, the first in Portugal. Surgery is still the gold standard for curative treatment and some patients with favourable prognosis may be identified. The overexpression of HER2 could select patients for targeted treatment and prompt tissue sampling in unresectable patients.