Abstract
BackgroundGallbladder cancer is a rare but highly malignant cancer, which often progresses to a metastatic stage when diagnosed because of its asymptomatic manifestation. In this study, we intended to analyze the prognostic value of metastatic gallbladder adenocarcinoma (GBA) with site-specific metastases.MethodsUsing the Surveillance, Epidemiology, and End Results (SEER) database, GBA patients diagnosed with metastases between 2010 and 2016 were selected to identify the prognosis according to the isolated metastatic sites, including liver, lung, bone, brain and distant lymph nodes (DL). Kaplan–Meier methods were used for survival comparisons and multivariable Cox regression models were constructed to find out independent factors that associated with survival.ResultsData from 1526 eligible patients were extracted from the SEER database. Among the patients, 788 (51.6%) had isolated liver metastases, 80 (5.2%) had isolated distant nodal involvement, 45 (2.9%) had isolated lung metastases, 21 (1.4%) had isolated bone metastases, 2 (0.1%) had isolated brain metastases and 590 (38.7%) had multiple metastases. No significant survival difference was shown between patients with single or multisite metastases (P > 0.05). Patients with isolated lung or DL metastases had significant better survival outcomes than those with isolated bone metastases (P < 0.05). Multivariate analysis showed that performing surgery at primary site, receiving chemotherapy were associated with better OS and CSS for patients with isolated liver or DL metastases.ConclusionsThe study showed that different metastatic sites affect survival outcomes in metastatic GBA patients. Highly selected subset of patients with liver or DL metastases might benefit from surgery at primary site.
Highlights
Gallbladder cancer is a rare but highly malignant cancer, which often progresses to a metastatic stage when diagnosed because of its asymptomatic manifestation
Smaller tumor size, high histological grade, performing surgery at primary site, receiving chemotherapy were associated with better overall survival (OS) and cancer specific survival (CSS) (Table 2)
We performed multivariate analyses of patients with isolated liver and distant lymph nodes (DL) metastases using the same method to further explore the independent prognostic factors on the OS and CSS, and the results suggested that for patients with isolated liver metastases, performing surgery at primary site, receiving chemotherapy were associated with better OS and CSS
Summary
Gallbladder cancer is a rare but highly malignant cancer, which often progresses to a metastatic stage when diagnosed because of its asymptomatic manifestation. Gallbladder cancer (GBC) is a rare gastrointestinal malignancy with an incidence of 1.13/100,000 [1], but it is the most common cancer in the biliary tract [2] and has a dismal prognosis; the 5-year overall survival rate is only 6.7% at stage IVB [3]. For T1a tumors, simple cholecystectomy is curative in over 90% of cases [5], and for T1b and more advanced GBA (stage II, III), radical surgery, including lymph node (LN) dissection, should be considered [5, 6]. The efficacy of radical surgery and adjuvant therapy for stage IV GBA remains controversial [7].
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