Survival Of Gallbladder Cancer Research Articles

Novel multifactor predictive model for postoperative survival in gallbladder cancer: a multi-center study

BackgroundGallbladder cancer (GBC) is a highly aggressive malignancy, with limited survival profiles after curative surgeries. This study aimed to develop a practical model for predicting the postoperative overall survival (OS) in GBC patients.MethodsPatients from three hospitals were included. Two centers (N = 102 and 100) were adopted for model development and internal validation, and the third center (N = 85) was used for external testing. Univariate and stepwise multivariate Cox regression were used for feature selection. A nomogram for 1-, 3-, and 5-year postoperative survival rates was constructed accordingly. Performance assessment included Harrell's concordance index (C-index), receiver operating characteristic (ROC) curves and calibration curves. Kaplan-Meier curves were utilized to evaluate the risk stratification results of the nomogram. Decision curves were used to reflect the net benefit.ResultsEight factors, TNM stage, age-adjusted Charlson Comorbidity Index (aCCI), body mass index (BMI), R0 resection, blood platelet count, and serum levels of albumin, CA125, CA199 were incorporated in the nomogram. The time-dependent C-index consistently exceeded 0.70 from 6 months to 5 years, and time-dependent ROC revealed an area under the curve (AUC) of over 75% for 1-, 3-, and 5-year survival. The calibration curves, Kaplan-Meier curves and decision curves also indicated good prognostic performance and clinical benefit, surpassing traditional indicators TNM staging and CA199 levels. The reliability of results was further proved in the independent external testing set.ConclusionsThe novel nomogram exhibited good prognostic efficacy and robust generalizability in GBC patients, which might be a promising tool for aiding clinical decision-making.

The impact of lymph node ratio on survival in gallbladder cancer: a national cancer database analysis

BackgroundThe study aimed to investigate the impact of lymph node ratio (LNR) on survival in patients with resectable gallbladder adenocarcinoma. MethodsWe retrospectively analyzed the National Cancer Database from 2004 to 2020. We included patients with gallbladder adenocarcinoma who had undergone resection of the primary site as well as adequate lymphadenectomy. Exclusions comprised patients with distant metastasis and missing key data. LNR was calculated as a proportion of positive lymph nodes (LNs) to examined LNs. ResultsPatients were stratified into LNR groups: LNR0 - 343 patients (55%); 168 (26.9%) patients with LNR < 30%; and 113 (18.1%) with LNR ≥ 30%. The mean age was 67.3 ± 10.7 years, with 71.6% being female and 75.8% identifying as white. The mean overall survival (OS) was 52.8 months for the LNR0 group, 36.3 months for LNR < 30%, and 27 months for LNR ≥ 30% (p < 0.001). The difference in survival was significant when adjusted for adjuvant chemotherapy status and surgical margins using Cox regression – HR 3.2 (2.4–4.5 95% CI) for LNR < 30% and HR 4.9 (3.5–6.8 95% CI) for LNR ≥ 30%. ConclusionThe study suggests that LNR is a valuable prognostic factor for resectable gallbladder cancer patients and could potentially guide treatment decisions.

The impact of lymph node ratio on survival in gallbladder cancer: national cancer database analysis

The impact of lymph node ratio on survival in gallbladder cancer: national cancer database analysis

Clinicopathological and prognostic significance of VEGF, PDGF-B, and HER2/neu expression in gallbladder cancer.

Gallbladder cancer (GBC) is usually diagnosed in advanced stages with poor survival. The molecular mechanisms of GBC still remain unexplored. Several angiogenesis factors play a pivotal role in tumor progression. We aimed to study the expression of VEGF, PDGF-B, and human epidermal growth factor receptor 2 (HER2/neu) and its association with clinicopathological features and survival in GBC. VEGF, PDGF-B, and HER2/neu expression was studied by immunohistochemistry (IHC) after histological evaluation in 91 GBC cases. The relationship between these markers and clinicopathological features and survival was explained through the Cox regression model and Kaplan-Meier method. VEGF, PDGF-B, and HER2/neu overexpressed in 45, 79, and 68% GBC cases, respectively. VEGF was significantly overexpressed in GBC without gall stones (GS) (p = 0.007) and with moderately and poorly differentiated tumors (p = 0.012). HER2/neu was significantly overexpressed in GBC with GS (p = 0.022). Median overall survival (OS) was 39 months (95% CI: 23-55). In univariate analysis, histological type (adenocarcinoma and papillary) vs. others (signet ring/mucinous/adenosquamous) (p = 0.004), depth of tumor infiltration (p = 0.017), distant metastasis (p = 0.012), and adjuvant therapies (chemotherapy/radiotherapy) (p = 0.083) were associated with poor prognosis. Multivariate survival analysis showed histological type (p = 0.004) and distant metastasis (p = 0.032) to be independent prognostic factors for OS. Histological type (p = 0.002), distant metastasis (p = 0.003), and depth of tumor infiltration (T3-T4) (p = 0.012) showed poor median survival. Poor survival was seen in VEGF and HER2/neu positive cases. Overexpression of VEGF, PDGF-B, and HER2/neu might be possible prognostic biomarkers in GBC. Poor survival of VEGF and HER2/neu positive cases indicates the possibilities of using their blockers as therapeutic agents.

Haematologic biomarkers and survival in gallbladder cancer: a systematic review and meta-analysis.

Gallbladder cancer is a rare malignancy characterised by poor survival with lack of durable response to treatment. Thus, novel biomarkers are needed to prognosticate patients. This systematic review and meta-analysis sought to examine the role of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet count (PC) and serum immune inflammation index in predicting the survival of patients with gallbladder cancer. A systematic search was done using PubMed, Cochrane, ClinicalTrials.gov and Google Scholar for articles published from inception until 8 February 2022. Hazard ratios (HR) with 95% confidence intervals (CI) were pooled and subgroup analyses were conducted according to treatment, region and cut-offs. The primary outcome of interest was overall survival (OS). Data were summarised using RevMan version 5.4. Twenty studies comprising 5,183 patients were included in the analysis. High neutrophil-lymphocyte ratio (HR 1.72, 95% CI 1.47-2.02), platelet-lymphocyte ratio (HR 1.51, 95% CI 1.33-1.72), monocyte-lymphocyte ratio (HR 1.96, 95% CI 1.46-1.64), PC (HR 1.20, 95% CI 1.02-1.40) and serum inflammation index (HR 1.73, 95% CI 1.36-2.18) were all associated with worse survival. The association was consistent across most subgroups on race and cut-offs with a trend towards poor survival for PC above 252.5. High neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, monocyte-lymphocyte ratio, PC and SII are associated with worse OS in gallbladder cancer and are potential biomarkers for prognostication. Prospective studies are recommended to further evaluate their use.

Estimating the influencing factors for T1b/T2 gallbladder cancer on survival and surgical approaches selection.

The influencing factors, especially time to treatment (TTT), for T1b/T2 gallbladder cancer (GBC) patients remain unknown. We aimed to identify the influencing factors on survival and surgical approaches selection for T1b/T2 GBC. We retrospectively screened GBC patients between January 2011 and August 2018 from our hospital. Clinical variables, including patient characteristics, TTT, overall survival (OS), disease-free survival (DFS), surgery-related outcomes, and surgical approaches were collected. A total of 114 T1b/T2 GBC patients who underwent radical resection were included. Based on the median TTT of 7.5 days, the study cohort was divided into short TTT group (TTT ≤7 days, n = 57) and long TTT group (TTT >7 days, n = 57). Referrals were identified as the primary factor prolonging TTT (p < 0.001). There was no significance in OS (p = 0.790), DFS (p = 0.580), and surgery-related outcomes (all p > 0.05) between both groups. Decreased referrals (p = 0.005), fewer positive lymph nodes (LNs; p = 0.004), and well tumor differentiation (p = 0.004) were all associated with better OS, while fewer positive LNs (p = 0.049) were associated with better DFS. Subgroup analyses revealed no significant difference in survival between patients undergoing laparoscopic or open approach in different TTT groups (all p > 0.05). And secondary subgroup analyses found no significance in survival and surgery-related outcomes between different TTT groups of incidental GBC patients (all p > 0.05). Positive LNs and tumor differentiation were prognostic factors for T1b/T2 GBC survival. Referrals associating with poor OS would delay TTT, while the prolonged TTT would not impact survival, surgery-related outcomes, and surgical approaches decisions in T1b/T2 GBC patients.

Survival analysis and prognostic factors of the carcinoma of gallbladder

BackgroundThe present study aims to evaluate the survival status of patients with gallbladder cancer (GBC) and explore the prognostic factors for the improvement and preventions.MethodsThe study consists of 176 patients with clinically diagnosed gallbladder cancer; the study was conducted between 2019 and 2021 registered at Kamala Nehru Memorial Cancer Hospital, Prayagraj, India. The survival rates were analyzed by the Kaplan-Meier method; survival rate difference was analyzed by log-rank test, prognosis factors; and hazard ratio for mortality outcomes was estimated using Cox regression method.ResultsThe overall median survival time of patients was 5 months with the 1-year, 2-year, and 3-year survival rates of 24.4%, 8.5%, and 4.5%, respectively. The 3-year survival for patients with jaundice was 2.9%, liver infiltration (4.2%), gallstones (0.8%), and with advanced tumor grade (1.4%). Elderly GBC patients had lower survival rates (3.8%), while the 3-year overall survival for patients residing in urban areas dropped to zero. No patients in the tumor stage (T3/T4) and with distance metastasis stage survived in 3 years, while only 1.1% of patients with advanced nodal stage survived. On receiving surgery and radiation therapy, the 3-year survival rate increased to 19.5% and 35%, respectively. The results of multivariate analysis showed that urban region (HR = 1.568, p = 0.040), gallstone or not (1.571, p = 0.049), N stage (HR = 1.468, p = 0.029), and M stage (HR = 2.289, p < 0.0001) were independent risk factors for prognosis, while surgery or not (HR = 0.573, p = 0.030) was the protective factor for the prognosis of GBC.ConclusionThe overall survival of GBC in the Gangetic belt is poor. The geographical region of patients, gallstones, and N and M stage was the risk factors for prognosis, while surgery or not was the protective factor for the prognosis of GBC.

Preoperative skeletal muscle fat infiltration is a strong predictor of poorer survival in gallbladder cancer underwent surgery

Recently, a decrease in skeletal muscle, termed sarcopenia, has been reported to be associated with poorer survival of patients in several types of cancer. However, few studies have investigated the association between sarcopenia and the survival of patients with gallbladder cancer. A total of 88 patients undergoing curative resection for advanced gallbladder cancer were included in this study. The quality of skeletal muscle was assessed by the intramuscular adipose tissue content (IMAC), and the quantity of skeletal muscle was assessed by the psoas muscle index (PMI), measured on preoperative computed tomography. The optimum cutoff values for IMAC and PMI for predicting the overall survival in each sex were determined using a minimum p value approach. Clinicopathological factors, IMAC and PMI were retrospectively analyzed to identify the predictors of overall survival (OS). The cutoff values for IMAC were-0.3 in males and 0.04 in females. The numbers of patients with low IMAC and high IMAC were 42 and 46, respectively. The cutoff values for PMI were 7.3cm2/m2 in males and 5.0cm2/m2 in females. The numbers of patients with low PMI and high PMI were 22 and 66, respectively. A multivariate analysis revealed that pT stage (pT3/4, hazard ratio [HR]=6.72, p=0.004), high IMAC (HR=4.12, p<0.001), Bile duct infiltration (present, HR=2.82, p=0.046), high age (≥72 years old, HR=2.64, p=0.010), major hepatectomy (performed, HR=2.50, p=0.031) and pN1/2 (HR=2.17, p=0.010) as independent prognostic factors. IMAC was independent prognostic factor for resected advanced gallbladder cancer, so the quality of skeletal muscle more strongly predicted survival than the quantity of skeletal muscle.

Propensity Score Analysis of Outcomes Following Laparoscopic or Open Radical Resection for Gallbladder Cancer in T2 and T3 Stages

BackgroundAlthough laparoscopic radical resection (LRR) has long been contraindicated in gallbladder cancer (GBC), recent studies have demonstrated laparoscopic surgery did not adversely affect the perioperative and survival outcomes of GBC patients. However, these literatures are mainly focused on GBC of relatively early stages or incidental GBC. This study aimed to investigate the perioperative and long-term outcomes of LRR versus open radical resection (ORR) for GBCs in T2 and T3 stages. MethodsA retrospective study was conducted on 99 patients with GBC of T2 and T3 stages who underwent radical resection at Zhejiang Provincial People’s Hospital from January 2010 to December 2020. A 1:1 propensity score matching (PSM), which is widely used to reduce selection bias, was performed to compare the surgical outcomes and long-term prognosis between LRR and ORR. A logistic regression analysis was implemented to identify the predictive risk factors of postoperative overall survival. ResultsBy using PSM, the baseline characteristics of two groups (with 30 patients in each group) were generally well balanced. In the LRR group, the length of operation was significantly longer than the ORR group, but the intraoperative bleeding and postoperative days of hospital stay were significantly decreased compared to the ORR group. The two groups showed comparable outcomes regarding the incidence of biliary reconstruction, lymph node yield, the incidence of postoperative morbidities, the incidence of Clavien–Dindo (C–D) grades III–IV, the days of drainage tubes indwelling, mortality at 30 postoperative days and 90 postoperative days, and the incidence of port-site metastasis. The 1-, 2-, and 3-year overall survival rates were 61.2, 40.1, and 30.1%, respectively, in the LRR group, and 53.3, 40.1, and 40.1%, respectively, in the OLR group (P = 0.644). On multivariate analysis, T stage, vascular invasion, and tumor differentiation were found to be the independent risk factors for overall survival of GBC in T2 and T3 stages. ConclusionsFor GBC in T2 and T3 stages, LRR can achieve comparable perioperative outcomes and similar long-term survival benefit compared to ORR. LRR tends to show advantages over ORR regarding intraoperative bleeding and postoperative days of hospital stay.

Comparative Study of Clinicopathological Features and Outcome of Standard Extended Cholecystectomy in Gall Bladder Cancer (GBC) with or without Adjacent Organ Involvement

Background: Curative surgery is the only treatment to increase the survival in GBC. Standard surgical procedure in resectable GBC is extended cholecystectomy. This study was done to compare the clinicopathological features and the outcome among patients who underwent standard extended cholecystectomy (EC) alone and those with EC and enbloc excision of surrounding structure (ECP) .

Impact of lymph nodal stage on gallbladder cancer survival after extended cholecystectomy and adjuvant radiochemotherapy: long-term results from an oncology institute, Chile.

IntroductionGallbladder cancer (GBC) is one of the most important causes of cancer death in Chile.Materials and methodsA retrospective review of 103 patients with a diagnosis of GBC who were treated with surgery and adjuvant radiochemotherapy (RT-CT) was carried out at the Oncological Institute of Viña del Mar, Chile. Of these, 56 underwent surgery with oncological criteria, in which the impact of lymph node involvement and prognostic factors for survival were analysed.ResultsThe median follow-up was 47.5 months. The 5-year survival of the patients operated on with oncological surgery was 55%, and for those resected without oncological criteria, it was 32% (p = 0.02). Regarding the impact of lymph node involvement, 5-year overall survival (OS) in patients with compromised lymph nodes was 32% versus 68% for patients without compromised lymph nodes (p = 0.006). Five-year OS in patients without involved nodes, with 1 involved node or with>1 involved node was 68%, 44% and 12%, respectively (p = 0.0002). The N ratio was grouped in 0, <10% and ≥10%. Five-year OS was 71%, 0% and 24%, respectively (p = 0.003). There was no evidence of differences in survival with respect to the number of lymph nodes studied.ConclusionOur data provide information regarding the importance of lymph node involvement in patients with GBC undergoing surgery with oncological criteria and adjuvant RT-CT. In the absence of randomised studies, it is suggested to have a more aggressive therapeutic approach in those patients with two or more involved nodes or with a lymph node ratio >10%.

Differences in Clinicopathological Factors and Outcomes after Major Liver Resection and Bile Duct Resection for Biliary Tract Cancers

Purpose: The surgical treatment of perihilar cholangiocarcinoma (PHC), intrahepatic cholangiocarcinoma (ICC) and gallbladder cancer (GBC) can be similar in case of hilar tumor infiltration. The aim of the present study was to investigate short- and long-term outcomes between these cancers operated with a major liver resection (≥3 Couinaud’s segments) and extrahepatic bile duct resection. Methods: All patients subjected to a major liver resection and bile duct excision for PHC, ICC and GBC at a single center between 2012-2019 were included. Clinicopathological factors and survival were compared between groups. Results: In total, 81 patients were included (52 PHC, 9 ICC, 20 GBC). Tumor size was 30, 67 and 48 mm for PHC, ICC, and GBC (P<0.001). Percentage node positivity and peritoneal invasion were 52, 67 and 85% (P=0.033) and 31, 44 and 50% (P=0.046), for PHC, ICC, and GBC. Mortality within 90 days was 4, 0 and 35% for PHC, ICC, and GBC (P=0.002). Median survival and 5-year survival excluding perioperative mortality were 31, 21 and 18 months, and 42, 13 and 20% for PHC, ICC, and GBC, respectively (P=0.197). Conclusion: PHC, ICC and GBC necessitating a major liver resection and bile duct resection for tumor clearance display differences in pathological features. Survival for GBC was low.

Survival Prediction in Gallbladder Cancer Using CT Based Machine Learning.

ObjectiveTo establish a classifier for accurately predicting the overall survival of gallbladder cancer (GBC) patients by analyzing pre-treatment CT images using machine learning technology.MethodsThis retrospective study included 141 patients with pathologically confirmed GBC. After obtaining the pre-treatment CT images, manual segmentation of the tumor lesion was performed and LIFEx package was used to extract the tumor signature. Next, LASSO and Random Forest methods were used to optimize and model. Finally, the clinical information was combined to accurately predict the survival outcomes of GBC patients.ResultsFifteen CT features were selected through LASSO and random forest. On the basis of relative importance GLZLM-HGZE, GLCM-homogeneity and NGLDM-coarseness were included in the final model. The hazard ratio of the CT-based model was 1.462(95% CI: 1.014–2.107). According to the median of risk score, all patients were divided into high and low risk groups, and survival analysis showed that high-risk groups had a poor survival outcome (P = 0.012). After inclusion of clinical factors, we used multivariate COX to classify patients with GBC. The AUC values in the test set and validation set for 3 years reached 0.79 and 0.73, respectively.ConclusionGBC survival outcomes could be predicted by radiomics based on LASSO and Random Forest.

Prognostic and Clinicopathological Significance of X-Box-Binding Protein 1 and N-Acetyltransferase 1 in Gallbladder Cancer.

Background: X-box-binding protein 1 (XBP1) and N-acetyltransferase 1 (NAT1) are involved in oncogenesis and progression of many human cancer types. However, the roles of XBP1 and NAT1 in gallbladder cancer (GBC) are never reported.Methods: We examined XBP1 and NAT1 expression in GBC and matched adjacent non-tumor tissues via Western blotting. Then, we assayed XBP1 and NAT1 expression in 215 GBCs, including 69 squamous cell/adenosquamous carcinomas (SC/ASCs) and 146 adenocarcinomas (ACs) with immunohistochemistry. Their prognostic and clinicopathological significance was further evaluated using the χ2 test or Fisher's exact test, Kaplan–Meier univariate survival analysis, and log-rank tests.Results: XBP1 expression was upregulated, and NAT1 expression was downregulated in GBC. Immunohistochemical results showed that XBP1 expression was negatively associated with NAT1 expression in GBC, including SC/ASC and AC. The rate of patients with an age of more than 45 years, positivity of lymph node metastasis, and invasion were significantly higher in SC/ASC than those in AC (all P < 0.05). The percentage of XBP1-positive and NAT1-negative expression was significantly higher in the cases with poor differentiation, advanced tumor, nodes, and metastases (TNM) stage, lymph node metastasis, invasion, and only receiving biopsy in GBC, SC/ASC, and AC (all P < 0.05). XBP1-positive and NAT1-negative expression was positively related to larger tumor size (>3 cm) in GBC and AC. There was a negative association between XBP1 and NAT1 expression in GBC, SC/ASC, and AC (all P < 0.05). Positive XBP1 and negative NAT1 expression was closely associated with decreased overall survival in GBC, SC/ASC, and AC patients (all P < 0.05). The multivariate Cox regression analysis showed that positive XBP1 or negative NAT1 expression was an independent factor for poor prognosis in gallbladder SC/ASC and AC patients.Conclusions: This study indicates that positive XBP1 and negative NAT1 expression are closely associated with the clinicopathological and biological behaviors and poor prognosis in GBC.

Prediction Efficacy for Clinical Outcome of Prognostic Nutritional Index in Patients with Resectable Biliary Tract Cancer Depends on Sex and Obstructive Jaundice Status.

The Prognostic Nutritional Index (PNI), a marker of nutritional status and systemic inflammation, is a proven prognostic biomarker in some cancers. The predictive value of PNI in biliary tract cancer (BTC) has not been established. The aim of this study was to determine the relationship between the PNI and outcomes of resectable BTC. In total, 430 patients with stage I-III resectable BTC [gallbladder cancer (GBC), n = 212; cholangiocarcinoma (CHO), n = 218] who had attended Fudan University Zhongshan Hospital were enrolled. The relationship between the PNI and clinical outcomes was evaluated both in the whole cohort and in selected subgroups. Eligible patients were classified into PNI-low (PNI < 45) and PNI-high (PNI ≥ 45) groups. The PNI-low group had significantly worse overall survival (OS) in both the whole cohort (p = 0.002) and in the GBC subgroup (p = 0.001), but had similar OS as the PNI-high group in the CHO subgroup (p = 0.328). Multivariate analysis revealed that low PNI is an independent risk factor for worse survival in GBC (hazard ratio 1.623, 95% confidence interval 1.063-2.480, p = 0.026). PNI was found to predict clinical outcome in women (p < 0.001) and patients without obstructive jaundice (p = 0.017) with GBC, but was not a prognostic factor in any subgroup with CHO. The estimated area under the time-dependent receiver operating characteristic curve was significantly greater when TNM stage was combined with PNI in women with GBC. PNI is an independent predictor of OS in GBC, but not in CHO. It has no prognostic value in men with GBC or patients with obstructive jaundice.

Lung and gallbladder cancer survival in north India: an ambidirectional feasibility cohort study using telephone interviews

Background We report the feasibility of using telephones for active surveillance of cancer survival and also present absolute survival rate and its predictors for lung cancer (LC) and gallbladder cancer (GBC) in north India. To date, such information from resource intensive settings is limited. Methods Study participants were 530 men and women (259 LC and 271 GBC), registered at ‘Post Graduate Institute of Medical Education and Research’, Chandigarh. Eligible patients were diagnosed with LC or GBC between ages 30 and 69 years during a five-year period from January 1 2010 through December 31 2014, and had a valid telephone number. Information on socio-demographic factors, disease characteristics and treatment status was abstracted from medical records. Participants (or their family/relatives) were followed-up with telephone interviews (March 1 2016 to July 31 2016) to ascertain vital status. Absolute 1-, 3- and 5-year survival rates were calculated using Kaplan-Meier method; weighted Cox Proportional Hazards regression multivariable models were used to evaluate determinants of survival while accounting for losses to follow up. Results Over two-thirds of the participants or their families (66.7%) were successfully followed-up via telephone calls. Survival analysis included 354 participants (N=175 LC; 179 GBC) with 326 deaths observed during follow up (N=158 LC; 168 GBC). Absolute survival rates (expressed as percentages with 95% confidence intervals) for LC were 36.7 (29.5-44.7), 10.2 (6.1-15.6) and 2.1 (0.2-8.1) and for GBC 29.0 (22.6-35.8), 5.4 (2.5-9.8) and nil for 1-year, 3-years and 5-years post-diagnosis, respectively; GBC had lower survival rates than LC (P=0.049). Pre-treatment clinical extent of disease was the only significant predictor of survival rates especially for GBC. Conclusions Active follow-up of cancer patients through telephone calls is feasible and acceptable in India. Poor survival rates of both LC and GBC underscore the importance of active surveillance by reaching out to family members through practically feasible methods.

Infiltration of the Mascagni Node is a Strong Prognostic Factor for Gall Bladder Cancer Discovered in Resected specimen.

Introduction: The infiltrative node is a strong prognostic indicator of survival in gallbladder cancer. The profile of the Mascagni ganglion (Ganglion of the neck of the gallbladder) has never been studied and taken into account for the form of histological discovery. The purpose of this retrospective study is to assess the impact of the Mascagni lymph node profile (GGM) and the prediction of the presence of residual tumor tissue after a histological discovery of gallbladder cancer. Material and method: Forty-one patients were collected. Group A (No infiltrated Mascagni node) is made up of 15 patients while group B (infiltrated Mascagni node) is made up of 26 patients. Complementary secondary surgery was retained in 27 patients (65.8%) who underwent complimentary radical surgery in 16 (39%) of them and palliative surgery for 10 others (24,4%). Sixteen patients (39%) did not have secondary surgery. The mean time to reopen was 93.9 (48-166) in group A and 85.6 (21-230) days (p=0.5). Only 2 patients (13.3%) of group A had a residual tumor (carcinomatosis) and 100% of patients of group B presented this residual tumor with or without second surgery (p&lt;0.001). Result: No patient of group A had infiltrated lymph node even after second surgery while 92.3% (24/26) of group B had finally infiltrated lymph node (results of two interventions) (p&lt;0.001). Survival is significantly higher in-group A than in-group B. with global five-year survival reaching 46.6% vs only 03.8%. Free survival is significantly higher for group A than group B (73.3% (11/15) vs 03.8% (3/26). The survival is also significantly higher for both cholecystectomy alone and radical secondary surgery with 62.5% (05/08) vs 00% (00/16) (p &lt; 0.05) and 85.60% (06/07) vs 30% (03/10) respectively (p&lt;0.01). Conclusion: GGM is a strong prognostic factor for gall bladder cancer discovered on the resected specimens. It must be noted systematically on the histological reports and be taken into account before the secondary radical surgery.

Survival of Gallbladder Cancer with Infiltrative Node Beyond the Hepatic Pedicle

Survival of Gallbladder Cancer with Infiltrative Node Beyond the Hepatic Pedicle

Trends in Treatment and Survival of Gallbladder Cancer in the Netherlands; Identifying Gaps and Opportunities from a Nation-Wide Cohort.

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.

Treatment Modality and Trends in Survival for Gallbladder Cancer: a Population-Based Study.

There are only a few reports on the treatment-based survival of gallbladder cancer (GBC). The primary objective of this study was to examine the change in treatment modality and the related trends in the survival of GBC. This study includes all cases of primary GBC diagnosed in the province of Ontario, Canada, from January 2007 to December 2015 with known disease stage. Treatment modalities were classified as no treatment, radiation or chemotherapy, and surgical resection. We examined the association between surgical resection and demographics and tumor characteristics and estimated the trends in survival based on treatment modality. In total, 564 patients with GBC were identified, of which 374 (66.3%) were female. Although there were no significant trends in treatment modalities over the study period (p = 0.276), survival rates improved for all treatment modalities over time. There was a 35% increase in 5-year survival for the surgical resection group from 2007 to 2015. For patients with stage I-II disease, the 5-year survival rate increased 40% over time. The highest 5-year survival was observed for the surgical resection group in patients with stage I-II disease (0.533 (95% CI, 0.514-0.552)) while the average 5-year survival rate for all patients over the study period was 0.247 (95% CI, 0.228-0.266). Most cases of GBC continue to be diagnosed in the late stage. Five-year survival for the surgical resection group has markedly improved over time, specifically for patients with stage I-II disease which increased from 30% in 2007 to 70% in 2015.