Abstract
(1) Background: The AJCC Cancer Staging Manual, Eighth Edition, subdivided T2 GBC into T2a and T2b. However, there still exist a lack of evidence on the prognostic significance of tumor location. The aim of the present study was to examine the existing evidence to determine the prognostic significance of tumor location of T2 gallbladder cancer (GBC) and to evaluate the optimal surgical extent according to tumor location. (2) Methods: We searched for relevant literature published in the electronic databases PubMed, MEDLINE, Web of Science, Cochrane Library, and Embase before September 2020 using search terms related to gallbladder, cancer, and stage. Data were weighted and pooled using random-effects modeling. (3) Results: Seven studies were deemed eligible for inclusion, representing a cohort of 1789 cases of resected T2 GBC. The overall survival for T2b tumor was significantly worse than that for T2a tumor (HR, 2.141; 95% confidence interval (CI), 1.140 to 4.023; I2 = 71.4%; Pchi2 = 0.007). The rate of lymph node metastasis was lower in the T2a group (26.6%) than in the T2b group (36.6%) (OR, 2.164; 95% CI, 1.309 to 3.575). There was no evidence of a survival difference between the patients who underwent extended cholecystectomy and simple cholecystectomy in T2a GBC (OR, 0.802; 95% CI, 0.618 to 1.042) and T2b GBC (OR, 0.820; 95% CI, 0.620 to 1.083). (4) Conclusions: Hepatic side tumor was a significant poor prognostic factor in T2 GBC. Extended cholecystectomy and simple cholecystectomy showed comparable survival outcomes in T2 GBC, and additional large-scale prospective studies are warranted to establish evidence-based treatment guidelines for T2 GBC.
Highlights
Gallbladder cancer (GBC) is the most common biliary tract malignancy and traditionally has been associated with poor prognosis due to an asymptomatic course in early stage and being diagnosed in an advanced stage
The full texts of the remaining nine studies were reviewed in detail and two studies were excluded for the following reasons: did not report interest of outcomes [17,18]
This study is important because it is the first meta-analysis to evaluate the prognostic significance of tumor location of T2 GBC given the background of the low incidence of this disease preventing well-designed randomized trials
Summary
Gallbladder cancer (GBC) is the most common biliary tract malignancy and traditionally has been associated with poor prognosis due to an asymptomatic course in early stage and being diagnosed in an advanced stage. Because of the wide application of routine health checkups and advancements in imaging modalities, cases of early GBC have increased, and they show by far the best prognosis—close to 100% 5-year survival rate in some series [1,2]. (early), T3 and T4 (advanced) GBC, the prognosis of T2 GBC is very heterogeneous and is hard to predict. T2a GBC has been generally thought to have better survival than T2b GBC, there still remains controversy on the superior prognosis of T2a over T2b tumors because the data were not validated through a large cohort study before publication of the AJCC Cancer Staging Manual, Eighth Edition [8]. The gallbladder has a unique anatomy, and this anatomy might be associated with the tumor invasion, the mode of tumor spread and prognosis
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