Impact of Primary Tumor Resection on Survival of Patients with Metastatic Gallbladder Carcinoma: A Population-Based, Propensity‑Matched Study

Abstract

Background Gallbladder carcinoma (GBC) is relatively rare but highly aggressive and it has poor prognosis, especially for metastatic GBC. We aimed to determine the prognostic significance of primary tumor resection on patients with metastatic GBC. Material/Methods The records of patients with GBC with distant metastasis from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier methods were used to compare overall survival (OS) and carcinoma-specific survival (CSS) between patients receiving primary tumor resection and those without surgery. Cox regression analysis was conducted to identity independent factors significantly associated with survival. In addition, a propensity score-matched analysis was performed to adjust for the heterogeneity between the groups. Results Of the 1337 patients included, 496 patients underwent primary tumor resection and 841 patients did not. Multivariate Cox regression analysis showed that OS (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.48–0.66, P <0.001) and CSS (HR: 0.57, 95% CI: 0.48–0.66, P <0.001) were significantly improved in patients receiving surgical resection of the primary tumor lesion in the unmatched cohort. Additionally, in the matched cohort, univariate Cox regression analysis similarly indicated that performing surgery at the primary site was associated with better OS (HR: 0.62, 95% CI: 0.50–0.77, P <0.001) and CSS (HR: 0.61, 95% CI: 0.50–0.762, P <0.001). Conclusions This study indicated that primary tumor resection might prolong survival in patients with metastatic GBC.

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

“…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]. Therefore, tumor resection should be considered in the whole therapeutic strategy for initially inoperable GBC patients.…”

“…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.…”

New trends in diagnosis and management of gallbladder carcinoma

“…The repeated surgical resection for GB carcinoma, as for intrahepatic cholangiocarcinoma, has recently gained attention, and Laurenzi et al [ 4 ] reported good outcomes[ 4 ]. Xie et al [ 110 ] found that the excision of primary tumors in metastatic advanced GB carcinoma may improve survival[ 110 ]. Chan et al [ 111 ] proposed frozen sections in suspected cases of GB carcinoma to confirm the diagnosis[ 111 ].…”

Prophylactic Hyperthermic Intraperitoneal Chemotherapy for Patients at High Risk of Developing Gallbladder Cancer Peritoneal Metastases: Case Report and Rationale for a Prospective Clinical Trial

“…Surgical indications in this setting are extremely limited and remain controversial; however, there is increasing evidence of a potential survival advantage when surgery is pursued. A population-based propensitymatched study comparing patients with distant metastatic GBC who underwent resection of the primary tumor (n = 496) versus no surgery (n = 841) revealed significantly higher OS (HR 0.62, 95% CI: 0.50-0.77, p < 0.001) and CSS (HR: 0.61, 95% CI: 0.50-0.76, p < 0.001) in the surgery group [37]. These results imply that decreasing the overall tumor burden by removing the primary tumor, even with unresected metastatic lesions, there is an associated survival benefit.…”