Oncological outcomes in a Mexican cohort of patients with gallbladder cancer.

Abstract

518 Background: gallbladder cancer is the most common malignancy of the biliary tract. Treatment modalities and outcomes for this disease in Mexican population have been infrequently reported. Methods: we retrospectively reviewed medical records from 61 patients with histologically confirmed gallbladder cancer treated at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán from January 2005 to December 2015.Clinical and pathological information was recorded. Survival was estimated by Kaplan Meir method and compared by Log rank test. Results: we found 68.9% women and 31.1% men, with a median age of 68 years (32-93). Clinical stage was advanced in 65.6% (n=40), regional in 23% (n=14), localized in 4.9% (n=3) and in situ in 6.6% (n=4). For patients with localized disease (n=21), which included in situ, localized and regional disease, a potentially curative surgery was attempted in 100% of patients, achieving a R0 resection in 47.6% (n=10) of cases. The morbidity rate was 33.3% (n=7). There were 5 surgical deaths. For advanced disease (n=40), the initial treatment was: 42.5% (n=17) palliative surgery, 25% (n=10) palliative care and for 30% (n=12) systemic chemotherapy, more frequently gemcitabine plus cisplatin (n=7). At progression seven patients received second-line chemotherapy. Median overall survival (OS) in the global cohort was 5.6 months (IC 95, 2.4-8.77). According to clinical stage survival at 5 years was 100% for in situ and 67% for localized disease. Median survival was 6.3 months (IC 95, 2.3-10-3) for regional disease and 4.2 months (IC 95, 1.1-6.4) for advanced disease. For patients with localized disease not achieving R0 resection (p=0.03) and perineural invasion (p=0.025) were associated with decreased survival. For patients with advanced disease poor performance status (p=0.004) and absence of chemotherapy (p=0.002) were adverse prognostic factors. Conclusions: global poor outcomes may be explained by metastatic disease at presentation. Even for patients with apparent localized disease, a potentially curative resection could be offered to only half of the patients.