Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Korea Tumor Registry System-BiliaryPancreas (KOTUS-BP) Database Analysis

Abstract

Objective: The aims of this study were to investigate the clinical features and clinical outcomes of T2 gallbladder cancer (GBC) according to tumor location and determine the prognostic significance of tumor location and an appropriate surgical strategy for T2 GBC. Methods: Using Korea tumor registry system- biliarypancreas (KOTUS-BP) database, between 2000 and 2014, a total 707 patients with T2 GBC who underwent curative resection were enrolled. Results: 309 patients were T2a, and 398 patients were T2b. The incidence of lymph node metastasis in T2b tumor group was 37.5% and significantly higher than that of T2a tumor group (29.5%). After a median follow-up period of 43 (range 3-189) months, the 5-year disease-specific survival (76% vs. 69%, p=0.019) and disease-free survival of the T2a group were better than those of the T2b group (69% vs. 57%, p=0.002). However, there was no significant difference in survival between Stage IIa (T2aN0) and Stage IIb (T2bN0) (83% vs.74%, p=0.149). There were no significant survival differences between T2a and T2b groups according to whether hepatic resection was performed or not. Multivariate analysis revealed that lymph node metastasis was the only significant poor prognostic factor (hazard ratio 2.966, 95% confidence interval 1.960-4.489, p < 0.001). Conclusion: In T2 GBC, simple cholecystectomy and lymph node dissection for staging work-up could be recommended irrespective of tumor location. Postoperative adjuvant therapy should be considered, because lymph node metastasis was a significant poor prognostic factor, systemic recurrence was more common, and recurrence occurred more frequently among patients with lymph node metastasis.