Abstract
The prognostic significance of insurance status has been investigated in many types of malignancies, however, its impact on gallbladder cancer is yet not known. The purpose of this study was to determine the relationship between insurance status and gallbladder cancer survival. We searched the Surveillance, Epidemiology, and End Results dataset, and identified 1,729 gallbladder cancer cases. Kaplan–Meier methods and multivariable Cox regression models were used to analyze survival outcomes and risk factors. We found that individuals who had non-Medicaid insurance were more likely to be male, older, from wealthier area, and better-educated. Insurance status was confirmed as an independent prognostic factor for gallbladder cancer patients. Stratified analysis revealed that the uninsured status independently predicted unfavorable survival outcome at localized tumor stage and in white individuals. To conclude, insurance status is an important predictive factor for gallbladder cancer, and uninsured individuals are at the highest risk of death.
Highlights
Gallbladder cancer (GBC) is the fifth most common gastrointestinal malignancy and the most frequent malignancy of the biliary tract, accounting for 80%-95% of biliary tree cancers around the world [1]
After applying the inclusion and exclusion criteria, 1,729 GBC patients diagnosed during the 7-year study period in the SEER were included in the final cohort
The following nine factors were verified as independent prognostic factors for GBC (Table 2), including insurance status, gender, ethnicity, histotype, pathological grade, tumor size (≥3.5cm, hazard ratio (HR) 1.284, 95% confidence interval (CI) 1.074-1.536), TNM stage (III/IV, HR 1.765, 95% CI 1.407-2.214), SEER stage, and surgical therapy
Summary
Gallbladder cancer (GBC) is the fifth most common gastrointestinal malignancy and the most frequent malignancy of the biliary tract, accounting for 80%-95% of biliary tree cancers around the world [1]. The etiology of this tumor is complex, and there is a strong association with cholelithiasis [2]. The impact of insurance status on the survival of adult patients diagnosed www.impactjournals.com/oncotarget with GBC, has not yet been examined. We obtained data from the Surveillance, Epidemiology, and End Results (SEER) program, aiming to evaluate the association between insurance status and GBC cause-specific survival (GCSS) in the enrolled patients
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