Prognostic factors for patients with T2/T3 gallbladder cancer: Does extent of resection matter?
Background: Gallbladder cancer (GBC) portends a poor prognosis, and guidelines recommend radical cholecystectomy for patients with T1b and greater disease. We evaluated prognostic factors for T2 and T3 GBC among a contemporary cohort. Methods: The National Cancer Database (NCDB) was queried for patients with resected pathologic T2 and T3 GBC from 2004 to 2018. Patients were stratified by extent of resection: simple (SC) vs radical cholecystectomy (RC). Overall survival (OS) was compared with Kaplan-Meier and multivariable Cox proportional hazards methods. Results: Altogether, 10,107 patients (6426 [63.6 %] T2; 3681 [36.4 %] T3) were identified: 2203 (21.8 %) underwent SC and 7904 (78.2 %) RC. Patients with SC were more likely to have T2 disease, negative nodes, and positive margins. Tumor grade, node positivity, margin positivity, and T3 stage were associated with greater mortality. Treatment at an academic center and receipt of adjuvant chemotherapy were associated with improved survival. Extent of surgical resection was not associated with OS in unadjusted and adjusted analyses (adjusted HR 0.98, 95 % CI 0.92–1.05, p = 0.62). Discussion: Outcomes for patients with resected T2 and T3 GBC remain poor, though these retrospective data suggest RC is not associated with better OS. Multidisciplinary management and prospective investigation are needed to advance outcomes and facilitate selection of patients who may benefit from radical resection.
