The impact of race/ethnicity on gallbladder cancer: An analysis of The National Cancer Data Base

Abstract

Objective: Gallbladder cancer is a lethal disease with high incidence among Hispanics. However, overall survival (OS) and hazard ratios (HR) for survival among races/ethnicities have not been described. We hypothesize that stage-specific prognosis of gallbladder cancer is worse for Hispanics compared to similar non-Hispanic populations. Methods: Patients with gallbladder cancer were identified from the National Cancer Database (2007–2012), and categorized as Caucasian, Black, Hispanic, and Other. Descriptive statistics, OS, and Cox regression checking for two-way interactions were described. Results: The study identified 12,952 patients with gallbladder cancer. Median age was 71 years and 68.8% were female. The study identified 69.8% Caucasian, 13.9% Black, 11.0% Hispanic, and 5.4% Other. All-stage overall survival curves differed, with the greatest 5-year survival in Hispanic patients (27% vs. 23% Other, 18% Caucasian, and 17% Black, p < 0.001). Hispanics presented at earlier ages compared to Caucasians (67 vs 72 years, p < 0.001), were more likely to be uninsured (17.3% vs 3.9% p < 0.001), had lower income (p < 0.001), and education levels (p < 0.001) compared to Caucasians. When stratified by stage, Hispanics demonstrated greater OS for stage 0-3 disease. Following multivariate Cox regression modelling stratified for non-proportional hazards, only treatment at an academic facility (HR 0.90, 95% CI 0.84–0.97) and diagnosis year (HR 0.90, 95% CI 0.88–0.92) related to survival. Hispanic ethnicity did not show significance (p = 0.207). Conclusion: Hispanics exhibit the highest overall survival for gallbladder cancer, but after adjusting for covariates this does not appear to independently impact survival. Interestingly, treatment at an academic facility provides a survival benefit.