Jihoon Chang1, Jin-Young Jang2, Kyoung Bun Lee3, Mee Joo Kang1, Woohyun Jung1, Yong Chan Shin1, Sun-Whe Kim1. 1. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea. 2. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea. jangjy4@gmail.com. 3. Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
Abstract
BACKGROUND: Current guidelines for gallbladder cancer (GBC) contain controversies and some reported no survival improvement in GBC during 20 years. This study was designed to explore the chronologic change of survival outcomes in GBC and prognostic factors. METHODS: Clinicopathologic features and survival outcomes were analyzed in 692 consecutive GBC patients who underwent surgery between 1987 and 2014, including 255 treated in Period (P) 1 (1987-2000) and 437 in P2 (2001-2014). RESULTS: The mean age was 63.3 years. Curative resection rate was 59.2% and 5-year survival rate (5-YSR) after curative resection was 67.1%. Comparisons between P1 and P2 showed that mean age, asymptomatic presentation, extended cholecystectomy, curative resection, adjuvant chemotherapy, and tumor ≤ T2 were significantly higher during P2. The overall 5-YSR after curative surgery was significantly lower in P1. In patients who underwent curative resection, poor prognostic factors included symptomatic presentation, CA 19-9 >37 IU/ml, poor differentiation, tumor ≥ T3, and lymph nodal involvement. In patients who received non-curative surgery, well- or moderately differentiated tumor and adjuvant chemotherapy provide survival benefit. CONCLUSIONS: Detection of GBC at an early stage and optimal curative surgery may improve survival outcomes in GBC. Chemotherapy provides survival benefit in palliative setting.
BACKGROUND: Current guidelines for gallbladder cancer (GBC) contain controversies and some reported no survival improvement in GBC during 20 years. This study was designed to explore the chronologic change of survival outcomes in GBC and prognostic factors. METHODS: Clinicopathologic features and survival outcomes were analyzed in 692 consecutive GBC patients who underwent surgery between 1987 and 2014, including 255 treated in Period (P) 1 (1987-2000) and 437 in P2 (2001-2014). RESULTS: The mean age was 63.3 years. Curative resection rate was 59.2% and 5-year survival rate (5-YSR) after curative resection was 67.1%. Comparisons between P1 and P2 showed that mean age, asymptomatic presentation, extended cholecystectomy, curative resection, adjuvant chemotherapy, and tumor ≤ T2 were significantly higher during P2. The overall 5-YSR after curative surgery was significantly lower in P1. In patients who underwent curative resection, poor prognostic factors included symptomatic presentation, CA 19-9 >37 IU/ml, poor differentiation, tumor ≥ T3, and lymph nodal involvement. In patients who received non-curative surgery, well- or moderately differentiated tumor and adjuvant chemotherapy provide survival benefit. CONCLUSIONS: Detection of GBC at an early stage and optimal curative surgery may improve survival outcomes in GBC. Chemotherapy provides survival benefit in palliative setting.