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

Abstract

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.

Prognostic factors for resected cases with gallbladder carcinoma: a systematic review and meta-analysis

“…A total of 3 studies 50 , 52 , 55 with 617 cases were incorporated. Pooled results indicated that hepatic tumor shared more worse prognosis than peritoneal tumor and tumor location (peritoneal side vs hepatic side) was a prognostic factor for resected GBC (HR=1.85, 95% CI: 1.51–2.28, P <0.00001) (Figure S1L, Supplemental Digital Content 4, http://links.lww.com/JS9/C302 ) (Table 2 ).…”

“…A total of 20 studies 9 , 17 , 23 , 28 , 32 , 35 , 36 , 38 , 41 , 44 , 46 – 49 , 51 – 55 , 57 with 3864 cases were incorporated. Pooled results indicated that positive margin was a risk factor for OS among resected GBC (HR=2.90, 95% CI: 2.42–3.47, P <0.00001) (Figure S1N, Supplemental Digital Content 4, http://links.lww.com/JS9/C302 ) (Table 2 ).…”

“…Peri-neural invasion was demonstrated to be an independent prognostic factor on OS or DFS in resected patients with intrahepatic cholangiocarcinoma 68 . Similarly, based on the evidence regarding GBC patients, peri-neural invasion also indicated a worse prognosis 13 , 16 – 18 , 23 , 28 – 30 , 38 , 41 – 43 , 45 , 46 , 49 , 55 , 57 . Subsequently, when their results were pooled together, we were surprisingly to find that patients with peri-neural invasion shared a two times risk of death than those without peri-neural invasion (HR=2.20, P <0.00010) and it also served as an independent prognostic factor (HR=1.34, P =0.02000)…”