Role of Adjuvant Chemotherapy in Resected T2N0 Gall Bladder Cancer

Management of operable gall bladder cancer (GBC) is closely related to its tumor (T) and nodal (N) status. The magnitude of benefit with adjuvant chemotherapy in completely resected, node negative T2 cancers is not completely defined.

Retrospective analysis of patients diagnosed with pathological T2N0 (stage II, 7th edition AJCC) GBCs from January 2011 to June 2016 was evaluated for adverse risk factors, adjuvant treatment received, recurrence-free survival (RFS), and overall survival (OS). Survival analysis was done using Kaplan-Meier and Cox regression tools.

Of the 88 patients included, 30 received adjuvant chemotherapy while 58 were observed. The OS and RFS in the entire cohort were 82.9% and 62.7%, respectively, at a median follow-up of 44.18 months. The OS and RFS in the chemotherapy group were 85.1% and 76.4% while it was 81.4% and 55.5% in the observation group (p = 0.50). Recurrent disease was seen in 30.7%.The presence of lymphovascular invasion predicted inferior RFS (p = 0.031).

Adjuvant chemotherapy may reduce distant failure rates but did not improve OS in completely resected T2N0 GBC patients in this study. LVI predicted inferior RFS in T2N0 patients. An evaluation of adverse prognostic factors would help design personalized treatment strategies for this select cohort of T2N0 GBC.