Preoperative risk factors for early recurrence and relapse-free survival after R0 resection of gallbladder cancer

Gallbladder (GB) cancer is highly prevalent and fatal in South Korea. In operable patients, radical resection with an R0 margin combined with lymphadenectomy is the mainstay of curative-intent therapy. Despite R0 resection, a high recurrence rate has been observed, necessitating the identification of risk factors for recurrence after surgery. This study aimed to identify risk factors strongly related to recurrence after R0 resection of GB cancer. This single-center, retrospective cohort study included 148 patients with GB cancer who underwent R0 resection between January 1, 2014, and December 31, 2019. Variables were analyzed using statistical tools to identify risk factors related to prognosis. Early recurrence, disease progression within 1 year after R0 resection, relapse-free survival, and time from treatment to any event were analyzed with logistic regression and Cox regression analyses. Early recurrence was observed in 15.5% (N = 23) of patients. Based on statistical analysis, the independent risk factors for early recurrence and relapse-free survival were age > 65 years, glycated hemoglobin level > 6.5%, surgical T stage > T3, surgical N stage > N1, moderate or poor pathological differentiation, reversed albumin-globulin ratio, high C-reactive protein level, and high carbohydrate antigen 19-9 level. Advanced pathological stage and high inflammatory marker levels, reflecting high tumor burden, are associated with poor prognosis. High glycated hemoglobin levels were also associated with early recurrence. In conclusion, active screening for early detection, reduction of inflammatory conditions, and management of diabetes may reduce early recurrence after R0 resection of GB cancer.