Abstract
Gallbladder cancer (GBC) is rare in Western populations and data about treatment and outcomes are scarce. This study aims to analyze survival and identify opportunities for improvement using population-based data from a low-incidence country. GBC patients diagnosed between 2005 and 2016 with GBC were identified from the Netherlands Cancer Registry. Patients were grouped according to time period (2005–2009/2010–2016) and disease stage. Trends in treatment and overall survival (OS) were analyzed. In total 1834 patients were included: 661 (36%) patients with resected, 278 (15%) with non-resected non-metastatic, and 895 (49%) with metastatic GBC. Use of radical versus simple cholecystectomy (12% vs. 26%, p < 0.001) in early (pT1b/T2) GBC increased. More patients with metastatic GBC received chemotherapy (11% vs. 29%, p < 0.001). OS improved from 4.8 months (2005–2009) to 6.1 months (2010–2016) (p = 0.012). Median OS increased over time (2005–2009 vs. 2010–2016) in resected (19.4 to 26.8 months, p = 0.038) and metastatic (2.3 vs. 3.4 months, p = 0.001) GBC but not in unresected, non-metastatic GBC. In early GBC, patients with radical cholecystectomy had a median OS of 76.7 compared to 18.4 months for simple cholecystectomy (p < 0.001). Palliative chemotherapy showed superior (p < 0.001) survival in metastatic (7.3 versus 2.1 months) and non-resected non-metastatic (7.7 versus 3.5 months) GBC. In conclusion, survival of GBC remains poor. Radical surgery and palliative chemotherapy appear to improve prognosis but remain under-utilized.
Highlights
Gallbladder cancer (GBC) is a rare and highly lethal neoplasm of the biliary tract
Between 2005 and 2016, 1834 patients were diagnosed with GBC in the Netherlands (Figure 1)
Radical surgery in early GBC and palliative chemotherapy in unresectable and metastatic GBC significantly improved survival, these treatment modalities were only used in 33%
Summary
Gallbladder cancer (GBC) is a rare and highly lethal neoplasm of the biliary tract. GBC demonstrates marked geographic, age-, gender-, and ethnicity-related differences in incidence, implying (epi)genetics or environmental factors may play an important role in the development of GBC [1,2,3,4,5,6]. Other possible risk factors include cholelithiasis, obesity, gallbladder polyps, chronic infections, and an abnormal pancreaticobiliary duct junction [1,7,8]. Diagnosis—unless incidentally after cholecystectomy for benign gallbladder disease—is often made in an advanced stage and survival is extremely poor due to the limited efficacy of systemic therapy options [3]. The only treatment with curative intent is surgical resection. Due to late detection and a tendency towards invasive local growth, only 10% to
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