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Multicenter evaluation of adjuvant therapy for gallbladder cancer.

Publication ,  Journal Article
Wang, J; Hsu, CC; Fuller, CD; Pawlik, TM; Miller, RC; Czito, BG; Tuli, R; Ben-Josef, E; Herman, JM
Published in: J Clin Oncol
February 2011

251 Background: To assess the effect of adjuvant therapy in gallbladder adenocarcinoma (GBC). METHODS: Retrospective review was conducted at five institutions to identify pts who had surgery for confirmed dx of GBC from 1985-2008 (N = 189). Pts were excluded if they had chemo alone (N = 8), path other than adenoca (N= 7), carcinoma in situ (N=1), < 30 days of follow-up (N = 2), or missing data (N=14). Of the remaining 156 pts, 58 received surgery only and 98 received adj RT ± chemo. Kaplan-Meier was used for overall survival (OS) and Cox proportional hazards to compare risk factors. RESULTS: Median age of dx was 64.4, 68.0% were female, 37.9% had ≥ stage 2b, 37.2% had + nodes, and 32.1% had + margins. Overall, 35.9% of the patients had simple cholecystectomy (SC) only and 64.1% had radical resection (ER). mOS for pts treated with surgery alone was 49.7 months (95% CI: 24.8 to Inf). On univariate analysis, + margins (HR 2.72, p<0.001) was associated with worse OS, whereas ER compared to SC improved survival in both univariate (HR 0.46, p<0.001) and multivariate (HR 0.53, p=0.033) analyses after adjusting for node/margins, T-stage, adj RT, age, gender, and institution. mOS for the entire cohort vs. adj RT (median 50.4 Gy) ± chemo was 30.7 months (95% CI: 19.2 to 46.9) vs. 26.9 months (95% CI: 15.5 to 39.1). But, compared to surgery alone, the adj group was more likely to have had node +, margin +, or T-stage 3+ (all p<0.001). The adj RT group was also less likely than surgery alone pts to have undergone ER (p = 0.007). On multivariate analysis, decreased OS was also found for node + (HR 2.09, p=0.004), margin + (HR 1.84, p=0.043), and T3/T4 disease (HR 2.37, p=0.002). After adjusting for surgical extent, node, margin, T stage, age, gender, and institution, there was improved OS with adj therapy (HR: 0.43, p = 0.020). When stratified by surgical extent, the risk estimate for adj RT improved OS among those with SC (n=56; HR 0.20, p=0.135) and ER (n=100; HR 0.46, p=0.067), but was not statistically significant. CONCLUSIONS: ER was associated with improved OS, whereas node/margin+ and T-stage 3+ were associated with worse survival. In multivariate analysis, adj RT improved OS after surgery. Given the poor prognosis of GBC patients with advanced disease, consideration of adj therapy is appropriate. No significant financial relationships to disclose.

Duke Scholars

Published In

J Clin Oncol

EISSN

1527-7755

Publication Date

February 2011

Volume

29

Issue

4_suppl

Start / End Page

251

Location

United States

Related Subject Headings

  • Oncology & Carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wang, J., Hsu, C. C., Fuller, C. D., Pawlik, T. M., Miller, R. C., Czito, B. G., … Herman, J. M. (2011). Multicenter evaluation of adjuvant therapy for gallbladder cancer. J Clin Oncol, 29(4_suppl), 251.
Wang, J., C. C. Hsu, C. D. Fuller, T. M. Pawlik, R. C. Miller, B. G. Czito, R. Tuli, E. Ben-Josef, and J. M. Herman. “Multicenter evaluation of adjuvant therapy for gallbladder cancer.J Clin Oncol 29, no. 4_suppl (February 2011): 251.
Wang J, Hsu CC, Fuller CD, Pawlik TM, Miller RC, Czito BG, et al. Multicenter evaluation of adjuvant therapy for gallbladder cancer. J Clin Oncol. 2011 Feb;29(4_suppl):251.
Wang, J., et al. “Multicenter evaluation of adjuvant therapy for gallbladder cancer.J Clin Oncol, vol. 29, no. 4_suppl, Feb. 2011, p. 251.
Wang J, Hsu CC, Fuller CD, Pawlik TM, Miller RC, Czito BG, Tuli R, Ben-Josef E, Herman JM. Multicenter evaluation of adjuvant therapy for gallbladder cancer. J Clin Oncol. 2011 Feb;29(4_suppl):251.

Published In

J Clin Oncol

EISSN

1527-7755

Publication Date

February 2011

Volume

29

Issue

4_suppl

Start / End Page

251

Location

United States

Related Subject Headings

  • Oncology & Carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences