Impact of delay in adjuvant therapy for gallbladder adenocarcinoma

Abstract

Presenter: Ahmad Hamad MD | The Ohio State University Background: Receipt of adjuvant therapy for gallbladder adenocarcinoma (GBAC) is associated with a survival benefit. This study seeks to identify whether delays in initiation of adjuvant therapy among patients with resected GBAC impacts long-term survival. Methods: Patients with non-metastatic GBAC who underwent a curative-intent resection followed by adjuvant chemotherapy or chemoradiation between 2004 and 2017 were queried from the National Cancer Data Base. Patients who died within 30 or 90 days of surgery or did not receive surgical resection or any adjuvant therapy were excluded. Descriptive statistics and multivariate models were constructed to determine the relationship between delays in chemoradiation therapy beyond 12 weeks from surgery and overall survival (OS). Results: A total of 1,380 patients with stage 1 (n = 350, 25.4%), stage 2 (n = 954, 69.1%), and stage 3 (n = 76, 5.5%) disease were identified. Receipt of adjuvant therapy within 12 weeks was similar among all stages of disease (stage 1: 66.6% vs. stage 2: 65.3% vs. stage 3: 69.7%; P>0.05). The majority of patients received chemotherapy (n = 1,239, 90.6%) while approximately one-half of patients (n = 810, 58.7%) received chemoradiation. The median time to receipt of adjuvant chemotherapy was 93 days (Timely: 72 days vs Delayed: 137 days; P0.05). Conclusion: Current guidelines support the use of adjuvant therapy following resection of GBAC. This national cohort study demonstrates that delays in adjuvant therapy >12 weeks did not impact survival. As such, all patients who undergo resection for GBAC should still be considered for adjuvant therapy.