A Propensity Score Analysis of Chemotherapy Use in Patients With Resectable Gallbladder Cancer

Özer, Muhammet; Goksu, Suleyman Yasin; Sanford, Nina N.; Porembka, Matthew R.; Khurshid, Hajra; Ahn, Chul; Maxwell, Mary Claire; Beg, Muhammad Shaalan; Kazmi, Syed Mohammad Ali

doi:10.1001/jamanetworkopen.2021.46912

Cited by 19 publications

(15 citation statements)

References 41 publications

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“…An international multicentre study in 2015 showed that patients with T2h had higher vascular invasion, neural invasion, and lymph node metastasis than patients with T2p, and T2h were often associated with worse prognosis [13]. The gallbladder adjacent to the hepatic side has no serosal layer, there are as many as 20 (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) gallbladder veins, and the tumour easily metastasises to the liver bed through the gallbladder veins [14]. RC was found in 31.4% of patients after index cholecystectomy, with the liver being the most common residual site.…”

Section: Discussionmentioning

confidence: 99%

“…However, systematic reviews and meta-analyses pointed out that there is no strong evidence that adjuvant therapy is effective in GBC patients undergoing radical resection and only has some bene t in patients with positive lymph node disease, and positive surgical margins, or advanced disease [17,18]. A recent cohort study of 6391 GBC patients who underwent de nitive surgery from the US National Database (NCBD) showed that 49.2% received adjuvant chemotherapy and 1.6% received neoadjuvant chemotherapy [19]. Further propensity score matching analysis suggested that GBC patients who received adjuvant chemotherapy had a longer median OS than those who received surgery alone (22 vs. 18 months, HR = 0.78, 95% CI: 0.63-0.96), and lymph node-positive patients bene ted from neoadjuvant therapy (median OS: 30 vs. 14 months, P = 0.002).…”

Section: Discussionmentioning

confidence: 99%

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Residual cancer is a strong predictor of survival in T3 incidental gallbladder cancer

You

Xie

Ling

et al. 2022

Preprint

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Background and PurposeIndex cholecystectomy is insufficient for curing T3 incidental gallbladder cancer (IGC), and once residual cancer (RC) is found, the prognosis is often poor. The purpose of this study was to investigate the effect of RC on the prognosis and the optimal choice of adjuvant therapy for R0 reresection patients with T3 IGC.MethodsWe retrospectively reviewed data from patients with T3 IGC who underwent radical reresection from January 2013 to December 2018. RC was defined as histologically proven cancer at reresection. Demographics and tumour treatment-related variables were analysed in correlation with RC and survival. Adjuvant (Adj) chemoradiotherapy (CRT) was correlated with overall survival (OS) and disease-free survival (DFS).ResultsOf the 167 patients with IGC who underwent surgery, 102 underwent radical extended resection. Thirty-two (31.4%) RCs were found. Hepatic side tumours (T3h) and both side tumours (T3h+T3p) were associated with the presence of RC. In multivariate analysis, RC and lymph node metastasis were independent prognostic factors for DFS and OS (P <0.05). RC was associated with a significantly shorter median OS (20 vs. 53 months; P<0.01) and DFS (11 vs. 40 months; P<0.001) despite R0 resection. For R0 reresection patients with RC and/or lymph node metastasis, Adj CRT significantly improved OS (P=0.024).ConclusionResidual cancer and lymphatic metastasis are important factors for the poor prognosis of T3 IGC despite R0 resection, and these patients should actively receive adjuvant therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Residual cancer is a strong predictor of survival in T3 incidental gallbladder cancer

You

Xie

Ling

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…However, systematic reviews and meta-analyses pointed out that there is no strong evidence that adjuvant therapy is effective in GBC patients undergoing radical resection and only has some benefit in patients with positive lymph node disease, and positive surgical margins, or advanced disease [ 17 , 18 ]. A recent cohort study of 6391 GBC patients who underwent definitive surgery from the US National Database (NCBD) showed that 49.2% received adjuvant chemotherapy and 1.6% received neoadjuvant chemotherapy [ 19 ]. Further propensity score matching analysis suggested that GBC patients who received adjuvant chemotherapy had a longer median OS than those who received surgery alone (22 vs. 18 months, HR = 0.78, 95% CI: 0.63–0.96), and lymph node-positive patients benefited from neoadjuvant therapy (median OS: 30 vs. 14 months, P = 0.002).…”

Section: Discussionmentioning

confidence: 99%

Residual cancer is a strong predictor of survival in T3 incidental gallbladder cancer

et al. 2022

View full text Add to dashboard Cite

Background and purpose Index cholecystectomy is insufficient for curing T3 incidental gallbladder cancer (IGC), and once residual cancer (RC) is found, the prognosis is often poor. The purpose of this study was to investigate the effect of RC on the prognosis and the optimal choice of adjuvant therapy for R0 reresection patients with T3 IGC. Methods We retrospectively reviewed data from patients with T3 IGC who underwent radical reresection from January 2013 to December 2018. RC was defined as histologically proven cancer at reresection. Demographics and tumour treatment-related variables were analysed in correlation with RC and survival. Adjuvant (Adj) chemoradiotherapy (CRT) was correlated with overall survival (OS) and disease-free survival (DFS). Results Of the 167 patients with IGC who underwent surgery, 102 underwent radical extended resection. Thirty-two (31.4%) RCs were found. Hepatic side tumours (T3h) and both side tumours (T3h + T3p) were associated with the presence of RC. In multivariate analysis, RC and lymph node metastasis were independent prognostic factors for DFS and OS (P < 0.05). RC was associated with a significantly shorter median OS (20 vs. 53 months; P < 0.01) and DFS (11 vs. 40 months; P < 0.001) despite R0 resection. For R0 reresection patients with RC and/or lymph node metastasis, Adj CRT significantly improved OS (P = 0.024). Conclusion Residual cancer and lymphatic metastasis are important factors for the poor prognosis of T3 IGC despite R0 resection, and these patients should actively receive adjuvant therapy.

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“…Adjuvant and neoadjuvant chemotherapy were associated with increased survival for lymph node-positive GBC. These findings suggest that adjuvant chemotherapy and neoadjuvant chemotherapies should be considered in the treatment of GBC, especially when there is LNM ( 76 ).…”

Section: Neoadjuvant and Adjuvant Therapy For Gbcmentioning

confidence: 95%

Progress in gallbladder cancer with lymph node metastasis

Song

Zhang

et al. 2022

Front. Oncol.

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Gallbladder cancer (GBC) is a malignant tumor that originates from the mucosal lining of the gallbladder. It is distinctly regional and is common in certain geographic regions of developing countries. GBC has a high degree of insidiousness as well as a high propensity for metastatic spread, resulting in the majority of patients being diagnosed at an advanced stage. Lymph node metastasis (LNM) is fairly common in GBC patients and is an independent risk factor for a poor prognosis. This article is focused on the lymph node pathways and metastatic directions of GBC. Furthermore, it summarizes the different lymph node groupings, disease stages and treatments. In the future, it is of great significance to develop individualized treatment and predict the outcomes of GBC patients with different lymph node conditions.

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A Propensity Score Analysis of Chemotherapy Use in Patients With Resectable Gallbladder Cancer

Cited by 19 publications

References 41 publications

Residual cancer is a strong predictor of survival in T3 incidental gallbladder cancer

Residual cancer is a strong predictor of survival in T3 incidental gallbladder cancer

Residual cancer is a strong predictor of survival in T3 incidental gallbladder cancer

Progress in gallbladder cancer with lymph node metastasis

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