Adjuvant Therapy Use for Patients With Inadequately Resected T1b-T3 Gallbladder Cancer

Area of Science:

• Oncology
• Surgical Oncology
• Cancer Treatment

Background:

• Gallbladder cancer (GBC) often presents incidentally, with up to 90% of patients experiencing inadequate resection.
• Inadequate resection is defined as simple cholecystectomy for T1b-T3, Nx-N2, and M0 GBC.
• Adjuvant therapies (ATs) may improve outcomes in such cases.

Purpose of the Study:

• To evaluate the association between adjuvant therapies (ATs) and overall survival (OS) in patients with inadequately resected T1b-T3 GBC.
• To determine if ATs, including chemotherapy (CT) and chemoradiotherapy (CRT), improve survival outcomes.
• To identify patient subgroups that may benefit most from specific ATs.

Main Methods:

• Retrospective analysis of the National Cancer Database (2004-2016) for patients with T1b-T3, Nx-N2, M0 GBC who underwent inadequate resection.
• Utilized chi-square tests, multivariable logistic regression, Kaplan-Meier, and Cox proportional hazard models.
• Compared OS between patients receiving no AT, CT, or CRT.

Main Results:

• Of 1386 patients, 64% received no AT, 20% received CT, and 16% received CRT.
• Any AT was associated with prolonged median OS (22 months) compared to no AT (15 months, P < 0.01).
• Both CT (HR 0.76) and CRT (HR 0.59) significantly decreased the risk of death relative to no AT. CRT was more frequently used in older patients or those with comorbidities.

Conclusions:

• Adjuvant therapies are associated with improved overall survival in patients with inadequately resected T1b-T3 GBC.
• Chemoradiotherapy (CRT) shows promise as a treatment option for high-risk patients following inadequate resection.
• Further investigation into optimal AT strategies for GBC is warranted.