Comprehensive Real-World Outcomes of Multimodal Treatment in Gallbladder Cancer: A Prospective Cohort Study

Gallbladder cancer is an aggressive malignancy with disproportionately high incidence in North India. Most patients present at advanced stages, limiting curative options. This study aimed to prospectively evaluate outcomes of multimodal treatment-including neoadjuvant chemotherapy, surgery, and palliative chemotherapy-in a high-volume endemic center.

In this prospective observational cohort, 1,500 newly diagnosed gallbladder cancer patients were enrolled between September 2023 and May 2024. Clinical details, treatment intent, type of therapy, and survival outcomes were systematically recorded. Patients were stratified into three groups: neoadjuvant chemotherapy for borderline resectable disease, upfront curative surgery, and palliative chemotherapy for metastatic disease. Kaplan-Meier analyses were performed for overall survival (OS).

Of 1,500 patients, 1,203 (80.2%) presented with metastatic disease. Among 75 patients who received neoadjuvant chemotherapy, 61.3% progressed and only 12.7% could undergo curative surgery. Overall, 116 patients underwent surgical exploration and 92 received definitive surgery, achieving a 1-year overall survival of 88.5%. Of 768 patients planned for palliative chemotherapy, 294 received ≥ 1 cycle, with a median overall survival of 5 months.

In this real-world prospective cohort, surgery remains the only treatment associated with meaningful survival, while neoadjuvant chemotherapy and palliative chemotherapy yielded limited benefit. Early detection and standardized treatment pathways are urgently needed in endemic regions.