Individualizing care for patients with gallbladder cancer.

Area of Science:

• Surgical Oncology
• Gastrointestinal Oncology
• Clinical Evidence

Background:

• Gallbladder cancer is rare, with limited high-level evidence guiding patient care.
• Optimal treatment strategies for resectable gallbladder adenocarcinoma remain under investigation.

Purpose of the Study:

• To evaluate the survival benefits of different treatment modalities for gallbladder adenocarcinoma.
• To identify prognostic factors and develop a predictive tool for patient outcomes.

Main Methods:

• A National Cancer Database (NCDB) cohort study included 8484 patients with resected gallbladder adenocarcinoma (Stage IB-IVA) from 2004-2018.
• Survival analysis was performed comparing outcomes for cholecystectomy alone versus surgery beyond cholecystectomy, and the impact of adjuvant therapies.

Main Results:

• Median survival was 29.8 months. Surgery beyond cholecystectomy significantly improved survival across all studied stages (IB, II, III/IVA).
• Chemoradiotherapy demonstrated a survival benefit for Stage II and III/IVA disease. Adjuvant chemotherapy improved survival in Stage III/IVA but showed no benefit and a trend toward harm in Stage IB.
• A predictive nomogram was developed based on these findings.

Conclusions:

• Surgical resection beyond simple cholecystectomy offers a survival advantage for all stages of gallbladder adenocarcinoma.
• Adjuvant chemotherapy is beneficial for Stage III/IVA disease, and chemoradiotherapy benefits Stage II and higher, guiding treatment selection for advanced gallbladder cancer.