"Unexpected gallbladder cancer" -- was it really an accident?

Abstract

Background Gallbladder cancer (GBC) is a rare malignant disease. Unexpected gallbladder cancer (uGBC) is a kind of gallbladder cancer diagnosed in a special way that was previously thought to have a good prognosis that is now controversial. The proportion of uGBC, even the terminal stage in GBC, has increased dramatically, but this phenomenon has not received enough attention. Methods Data from all patients with GBC who underwent surgery at the Department of General Surgery of Xinhua hospital between January 1, 2018, and June 30, 2021, were collected. Demographics and clinical and pathological data of patients were analyzed. Prognosis was calculated by the Kaplan–Meier method. A Cox proportional hazards model was used to determine the effect on uGBC of common factors such as age and sex. Results Multivariate Cox regression analysis indicated that American Joint Committee on Cancer (AJCC) stage, CA125 level, and CA199 level were significantly correlated with worse overall survival (OS) (HR = 5.486, 95% CI: 1.165-25.824, P = 0.031, HR = 1.005, 95% CI: 1.001-1.010, P = 0.048 and HR = 1.004, 95% CI: 1.002-1.009, P = 0.0336). uGBC was not an independent prognostic factor (p=0.728). The best cutoff values of serum CA125 and CA199 were 15.59 and 41.20, respectively. The KM curve showed that high expression levels of CA125 (p=0.023) and CA199 (p=0.037) predicted worse survival. However, there was no difference in survival prognosis between uGBC and GBC. The rate of misdiagnosis and underdiagnosis of uGBC exceeds 60%. Conclusion AJCC stage and serum CA125 and CA199 levels are suggestive of the prognosis of gallbladder cancer. The prognosis of unexpected gallbladder cancer was not as good as expected. Underdiagnosis and misdiagnosis of uGBC are common worldwide. A thorough preoperative examination and rigorous intraoperative cytopathology are important.