Gallbladder adenocarcinoma: The prognostic significance of histologic grade

Abstract

Gallbladder adenocarcinoma (GBA) postresection 5-year survival rates are less than 5%, but when histologically confined to the mucosa or submucosa, survival rates of 64% (5 years) and 44% (10 years) have been reported. Whether any other histologic features of GBA have prognostic significance is unknown. This investigation was conducted to determine if GBA histologic grade correlates with survival. Thirty patients with advanced stage GBA participating in Eastern Cooperative Oncology Group (ECOG) treatment protocol EST-2273 served as the study material. Using glandular tumor grade criteria recommended by others, a panel of 7 ECOG pathologists categorized the GBA as either predominantly low or high histologic grade. Each patient's GBA histologic section measured no less than 1.0 X 1.0 cm. Predominant grade was defined as being that grade present in greater than 75% of the histologic section. Patient survival times by grade were calculated from date of initiation of chemotherapy until date of death. The 13-week low grade GBA patient survival was significantly longer than the 7-week high grade GBA patient survival (p less than 0.01). Stratification of patients by either high or low predominant histologic grade is recommended in future GBA treatment studies.

Epidemiology and Molecular Pathology of Gallbladder Cancer

“…In a large series of patients with gallbladder carcinoma, 24 no lymph node metastases were detected in gallbladder tumors invading the muscularis only, whereas 62 percent of the tumors invading the serosa showed regional lymph node metastasis. Patients with localized stage disease have much better survival rates (Stages I to III, five–year survival rate of 41.9 percent) than those with regional (Stage IV, 3.8 percent) or distant (Stage V, 0.7 percent) metastasis 27 , 28 . Similar results have been obtained using the TNM staging system of the International Union Against Cancer (UICC) and American Joint Committee on Cancer (AJCC), which has proven to be a good system for comparison of surgical results and prediction of patient outcome 29 , 30…”

Immunohistochemical Expression of Vascular Endothelial Growth Factor A in Advanced Gallbladder Carcinoma

“…15,[17][18][19]29,31 In this study, we found a statistically significant positive relationship between VEGF-A expression levels with histologic grade (P = 0.002) and TNM stage (P = 0.032). [34][35][36][37] Previously, a significant positive correlation was reported between VEGF-A expression and Nevin staging of GBC. Both parameters are poor prognostic markers in GBC.…”

Carcinoma of the gall‐bladder

“…In one study, the overall 5 year survival was only 1.4%, with a 4.5 month mean survival time 45 . Even post‐ resection, the prognosis is < 5% overall, but is better when the cancer is confined to the mucosa, giving at least 64 and 44%, 5 and 10 year survival rates, respectively 30 , 47 . More importantly, Japanese postoperative 5 year survival rates, especially after extended cholecystectomy for gall‐bladder carcinomas limited to the mucosa, are nearer to 100% 46 .…”

“…Of the different histological types, papillary carcinoma has the most favourable prognosis, quoted in one study as 47% at 2 years 6 . Higher tumour grades are associated with poor survival rates 46 –50 …”