The imortant role of adjuvant treatment in advanced gallblader cancer

Abstract

Background: The role of adjuvant treatment has been well established in cholangiocarcinoma, Gallbladder cancer (GC) is a rare and less studied tumor. Methods: We retrospectively analyzed all patients with gallbladder malignancy that underwent surgical removal of the gallbladder in our health system from 2007 to 2017. We compared clinical and oncological outcomes for two groups of patients: a group that received adjuvant treatment and a group that did not receive adjuvant treatment. The adjuvant treatment group was composed of patients who received either chemotherapy alone (19 patients) or chemo-radiation (21 patients). Results: Overall 69 patients with advanced (TNM stage III/IVa) gallbladder cancer (GBC) underwent resection for curative purposes. Among them, 40 patients (58%) were in the adjuvant treatment group and 29 patients (42%) were in the NO adjuvant treatment group. Gender (female, 58% vs 60%), ASA score (%) (I – 22 vs. 24, II - 39 vs. 37, III- 32 vs. 39, IV, 7 vs. 0), TNM stage IV (%, 17 vs. 10), and neoadjuvant chemotherapy administration (10% vs. 12%) were comparable (p = NS). The patients in theadjuvant treatment group were significantly younger (mean, years, 63 vs. 70, p = 0.03). Intraoperatively, surgical approach (laparoscopic, %, 28 vs. 25), incidental finding (%, 52 vs. 48), and tumor max dimension (mean, mm, 44 vs. 45) were all similar. Significantly more patients in the adjuvant treatment group underwent radical cholecystectomy (%, 69 vs. 98, p = 0.01). At median follow-up of 20 months, 43 patients recurred. Patients in adjuvant treatment group had significantly better survival (months, 25 vs. 10, p = 0.01). Similarly, the median disease-free survival was improved for patients in adjuvant treatment group (months, 18 vs. 8), although this didn’t reach statistical significance (p = 0.16). Conclusion: Adjuvant treatment has significant survival benefits for patients with advanced GBC and should be offered to patients with acceptable performance status. Despite these data, the application of adjuvant therapy after resection is not universally applied.