Abstract
Background: T2 gallbladder cancer (GBC) is subdivided into T2a and T2b by the American Joint Committee on Cancer (AJCC) 8th edition. However; there is a lack of evidence for the prognostic significance of tumor location and validation with large-scale studies is needed. The aims of this study were to investigate the clinical features and clinical outcomes of T2 GBC according to tumor location and determine the prognostic significance of tumor location and an appropriate surgical strategy. Methods: Between 2000 and 2014 the Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) database was used to identify and enroll a total 707 patients with pathologically diagnosed T2 GBC who underwent curative resection. Clinicopathological findings and long-term follow-up results were analyzed. Results: The incidence of lymph node metastasis in T2b was significantly higher than that of T2a tumors (37.9% vs. 29.5%, p = 0.032). The 5-year disease-specific survival of T2a was better than that of T2b tumors (74.8% vs. 65.4%, p = 0.019). There was no significant survival difference in T2a between extended cholecystectomy and simple cholecystectomy with lymph node dissection (81.8% vs. 73.7%, p = 0.361). However; there was a better survival trend for T2b tumor after extended cholecystectomy (71.7% vs. 59.3%, p = 0.057). Adjuvant chemotherapy was associated with improved survival for patients with lymph node metastasis in T2a (72.1% vs. 56.9; p = 0.022) and in T2b (68.2 vs. 48.5; p < 0.001). Multivariate analysis revealed that lymph node metastasis was the only significant poor prognostic factor (Hazard ratio 3.222; 95% confidential interval 1.960–4.489; p < 0.001). Conclusions: For T2 GBC; tumor location was not an independent prognostic factor. Lymph node metastasis was a significant poor prognostic factor and adjuvant chemotherapy should be considered for the patients with lymph node metastasis.
Highlights
Patients with T1 gallbladder cancer (GBC) generally have a good prognosis, whereas patients with advanced GBC such as T3 or T4 generally have a dismal prognosis
The newly published American Joint Committee on Cancer (AJCC), eighth edition has subdivided T2 GBC into two categories according to the location of the primary tumor: peritoneal side tumor and hepatic side tumor [7]
Since Shindoh and colleagues reported that GBC on the peritoneal side is associated with a higher five-year survival rate than that on the hepatic side [1], the superior prognosis of T2a over T2b GBC has been reproduced in several studies [2,3,4,5,6]
Summary
Patients with T1 gallbladder cancer (GBC) generally have a good prognosis, whereas patients with advanced GBC such as T3 or T4 generally have a dismal prognosis. The heterogeneous prognosis of T2 GBC has been demonstrated to be related in part to its location; a T2 GBC on the peritoneal side has a better prognosis, while a tumor on the hepatic side has worse prognosis [1,2,3,4,5,6]. Since Shindoh and colleagues reported that GBC on the peritoneal side is associated with a higher five-year survival rate than that on the hepatic side [1], the superior prognosis of T2a over T2b GBC has been reproduced in several studies [2,3,4,5,6]. The aims of this study were to investigate the clinical features and clinical outcomes of T2 GBC according to tumor location and determine the prognostic significance of tumor location and an appropriate surgical strategy. Lymph node metastasis was a significant poor prognostic factor and adjuvant chemotherapy should be considered for the patients with lymph node metastasis
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