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Improvement of clinical outcomes in the patients with gallbladder cancer: lessons from periodic comparison in a tertiary referral center
Author(s) -
Chang Jihoon,
Jang JinYoung,
Lee Kyoung Bun,
Kang Mee Joo,
Jung Woohyun,
Shin Yong Chan,
Kim SunWhe
Publication year - 2016
Publication title -
journal of hepato‐biliary‐pancreatic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 1868-6974
DOI - 10.1002/jhbp.330
Subject(s) - medicine , gallbladder cancer , asymptomatic , chemotherapy , gallbladder , stage (stratigraphy) , surgery , cancer , survival rate , cholecystectomy , adjuvant chemotherapy , general surgery , breast cancer , biology , paleontology
Background Current guidelines for gallbladder cancer (GBC) contain controversies and some reported no survival improvement in GBC during 20 years. This study was designed to explore the chronologic change of survival outcomes in GBC and prognostic factors. Methods Clinicopathologic features and survival outcomes were analyzed in 692 consecutive GBC patients who underwent surgery between 1987 and 2014, including 255 treated in Period (P) 1 (1987–2000) and 437 in P2 (2001–2014). Results The mean age was 63.3 years. Curative resection rate was 59.2% and 5‐year survival rate (5‐YSR) after curative resection was 67.1%. Comparisons between P1 and P2 showed that mean age, asymptomatic presentation, extended cholecystectomy, curative resection, adjuvant chemotherapy, and tumor ≤ T2 were significantly higher during P2. The overall 5‐YSR after curative surgery was significantly lower in P1. In patients who underwent curative resection, poor prognostic factors included symptomatic presentation, CA 19‐9 >37 IU/ml, poor differentiation, tumor ≥ T3, and lymph nodal involvement. In patients who received non‐curative surgery, well‐ or moderately differentiated tumor and adjuvant chemotherapy provide survival benefit. Conclusions Detection of GBC at an early stage and optimal curative surgery may improve survival outcomes in GBC. Chemotherapy provides survival benefit in palliative setting.