John R Bergquist1, Harsh N Shah2, Elizabeth B Habermann3, Matthew C Hernandez4, Tommy Ivanics4, Michael L Kendrick4, Rory L Smoot4, David M Nagorney4, Mitesh J Borad5, Robert R McWilliams6, Mark J Truty7. 1. Mayo Clinic Rochester, Department of Surgery, United States; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, United States. 2. Mayo Clinic Medical School, United States. 3. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, United States. 4. Mayo Clinic Rochester, Department of Surgery, United States. 5. Department of Hepatology, Mayo Clinic Scottsdale, United States. 6. Department of Medical Oncology, Mayo Clinic Rochester, United States. 7. Mayo Clinic Rochester, Department of Surgery, United States. Electronic address: Truty.Mark@mayo.edu.
Abstract
BACKGROUND: Ideal oncologic management of gallbladder carcinoma (GBCA) after complete surgical resection is unclear. We sought to define benefit of post-resection adjuvant systemic chemotherapy alone in T2 or greater gallbladder carcinoma utilising a large national dataset. STUDY DESIGN: The National Cancer Data Base (NCDB) 2004-2012 cohort was retrospectively reviewed for patients with GBCA (T2+) undergoing curative-intent resection and surviving at least 6 weeks. Univariate group comparisons, unadjusted Kaplan-Meier and adjusted Cox proportional hazards analyzed overall survival. RESULTS: 4373 patients were included (N = 2479 T2, N = 1894 T3/4). Overall, 22.1% of patients received adjuvant chemotherapy. Use of multi-agent chemotherapy increased during the study period. Patients receiving adjuvant therapy were younger, had fewer comorbidities, more often node-positive and more likely R1-margins than those receiving surgery alone. Unadjusted overall survival was improved in all patients with node-positive disease as well as for those with inadequate nodal staging. The benefit of chemotherapy persisted after adjustment for patient and tumor factors. CONCLUSION: Adjuvant systemic chemotherapy is associated with survival benefit in patients with T2 or greater GBCA with node positive disease. We recommend a multidisciplinary approach in these patients as less than 1-in-4 of them currently receive adjuvant chemotherapy. Future clinical trials should address adjuvant chemotherapy in node positive GBCA.
BACKGROUND: Ideal oncologic management of gallbladder carcinoma (GBCA) after complete surgical resection is unclear. We sought to define benefit of post-resection adjuvant systemic chemotherapy alone in T2 or greater gallbladder carcinoma utilising a large national dataset. STUDY DESIGN: The National Cancer Data Base (NCDB) 2004-2012 cohort was retrospectively reviewed for patients with GBCA (T2+) undergoing curative-intent resection and surviving at least 6 weeks. Univariate group comparisons, unadjusted Kaplan-Meier and adjusted Cox proportional hazards analyzed overall survival. RESULTS: 4373 patients were included (N = 2479 T2, N = 1894 T3/4). Overall, 22.1% of patients received adjuvant chemotherapy. Use of multi-agent chemotherapy increased during the study period. Patients receiving adjuvant therapy were younger, had fewer comorbidities, more often node-positive and more likely R1-margins than those receiving surgery alone. Unadjusted overall survival was improved in all patients with node-positive disease as well as for those with inadequate nodal staging. The benefit of chemotherapy persisted after adjustment for patient and tumor factors. CONCLUSION: Adjuvant systemic chemotherapy is associated with survival benefit in patients with T2 or greater GBCA with node positive disease. We recommend a multidisciplinary approach in these patients as less than 1-in-4 of them currently receive adjuvant chemotherapy. Future clinical trials should address adjuvant chemotherapy in node positive GBCA.
Authors: Muhammet Ozer; Suleyman Y Goksu; Nina N Sanford; Matthew Porembka; Hajra Khurshid; Chul Ahn; Mary Claire Maxwell; Muhammad Shaalan Beg; Syed M Kazmi Journal: JAMA Netw Open Date: 2022-02-01
Authors: John R Bergquist; Cornelius A Thiels; Christopher R Shubert; Tommy Ivanics; Elizabeth B Habermann; Santhi S Vege; Travis E Grotz; Sean P Cleary; Rory L Smoot; Michael L Kendrick; David M Nagorney; Mark J Truty Journal: Cancer Med Date: 2021-07-21 Impact factor: 4.452