Tailoring adjuvant chemotherapy for gallbladder cancer: moving beyond one-size-fits-all strategy

This study aimed to develop a prognostic model for risk stratification and guiding adjuvant chemotherapy (AC) for gallbladder cancer (GBC).

A population-based study was conducted on patients who underwent surgical resection for GBC. Independent predictors of overall survival (OS) were identified through univariate and multivariate Cox analyses. A prognostic model was constructed and validated to stratify patients into risk categories, and the impact of AC was assessed within each category.

A total of 2252 patients were included, with 1576 in the training set and 676 in the validation set. The 5-year OS rate was 27.30 %. Multivariate analysis identified age, tumor grade, N stage, tumor size, and sex as independent predictors of OS, forming the basis of a well-performing prognostic model. This model outperformed the TNM staging system in predictive accuracy, supported by receiver operating characteristic curves, calibration curves, and decision curve analysis. Patients were stratified into low-, intermediate-, and high-risk groups. AC showed varying effects: worse outcomes in low-risk, no significant benefit in intermediate-risk, and improved OS in high-risk patients.

Postoperative AC provides significant survival benefits for high-risk GBC patients but may not benefit intermediate- or low-risk groups, sparing them unnecessary treatment. These findings highlight the critical role of individualized treatment strategies to optimize outcomes in GBC management.