Examination of the characteristics of long-term survivors among patients with gallbladder cancer with liver metastasis who underwent surgical treatment: a retrospective multicenter study (ACRoS1406)

Abstract

Background Gallbladder cancer (GBC) with liver metastasis is considered unresectable. However, there have been infrequent reports of long-term survival in patients with GBC and liver metastases. Therefore, we examined the characteristics of long-term survivors of gallbladder cancer with liver metastasis. Methods A retrospective multicenter study of 462 patients with GBC (mean age, 71 years; female, 51%) was performed. Although patients with pre-operatively diagnosed GBC and liver metastasis were generally excluded from resection, some cases identified during surgery were resected. Result In patients with resected stage III/IV GBC (n = 193), the period 2007–2013 (vs. 2000–2006, hazard ratio 0.63), pre-operative jaundice (hazard ratio 1.70), ≥ 2 liver metastases (vs. no liver metastasis, hazard ratio 2.11), and metastasis to the peritoneum (vs. no peritoneal metastasis, hazard ratio 2.08) were independent prognostic factors for overall survival, whereas one liver metastasis (vs. no liver metastasis) was not. When examining the 5-year overall survival and median survival times by liver metastasis in patients without peritoneal metastasis or pre-operative jaundice, those with one liver metastasis (63.5%, not reached) were comparable to those without liver metastasis (40.4%, 33.0 months), and was better than those with ≥ 2 liver metastases although there was no statistical difference (16.7%, 9.0 months). According to the univariate analysis of resected patients with GBC and liver metastases (n = 26), minor hepatectomy, less blood loss, less surgery time, papillary adenocarcinoma, and T2 were significantly associated with longer survival. Morbidity of Clavien–Dindo classification ≤ 2 and received adjuvant chemotherapy were marginally not significant. Long-term survivors (n = 5) had a high frequency of T2 tumors (4/5), had small liver metastases near the gallbladder during or after surgery, underwent minor hepatectomy without postoperative complications, and received postoperative adjuvant chemotherapy. Conclusions Although there is no surgical indication for GBC with liver metastasis diagnosed pre-operatively, minor hepatectomy and postoperative chemotherapy may be an option for selected patients with T2 GBC and liver metastasis identified during or after surgery who do not have other poor prognostic factors.

Multimodal Conversion Therapy with TACE, Zimberelimab, Lenvatinib and S-1, Followed by Debulking Surgery to Prolong Survival for Gallbladder Cancer with Liver Metastasis: A Case Report

“…First, published studies supported debulking surgery to improve the outcome of metastatic GBC in the real world. Less liver metastasis was associated with improved OS in resected stage--IV GBC [12]. Either primary tumor resection or synchronous resection of the primary tumor and liver metastases can signi cantly prolong OS for metastatic GBC [11,13].…”

“…Radical surgery is the only curative therapy for BTC and is generally applied for early stage disease; however, many retrospective studies have suggested that resection of tumors can prolong the survival outcome of advanced GBC, even in those with liver metastasis [11][12][13][14]. Hence, surgery following conversion therapy might be feasible for GBC with liver metastasis to improve outcomes.…”

Successful conversion surgery for locally advanced gallbladder cancer after gemcitabine and nab-paclitaxel chemotherapy

“…We further classified advanced GBC into four subtypes, which combined the information derived from radiological imaging findings and the feasibility of achieving en bloc resection. Therefore, limited resectable liver metastasis, which is traditionally classified as M1 in the TNM staging system but has benefited from surgery ( 20 ), is classified at the locally advanced stage.…”

DNMT3A Cooperates with YAP/TAZ to Drive Gallbladder Cancer Metastasis

“…[ 1 ] GBC exhibits a highly aggressive behavior, and up to 70% of patients develop lymph node metastasis, liver metastasis, vascular invasion, perineural metastasis, or even distant metastasis, which limits the clinical therapeutic options owing to unresectable surgery and chemotherapy resistance. [ 2 ] Metastasis is the leading cause of cancer‐related deaths. Therefore, identifying the key drivers of the high metastatic potential of GBC is necessary.…”