TY - JOUR
T1 - Adjuvant systemic therapy after resection of node positive gallbladder cancer
T2 - Time for a well-designed trial? (Results of a US-national retrospective cohort study)
AU - Bergquist, John R.
AU - Shah, Harsh N.
AU - Habermann, Elizabeth B.
AU - Hernandez, Matthew C.
AU - Ivanics, Tommy
AU - Kendrick, Michael L.
AU - Smoot, Rory L.
AU - Nagorney, David M.
AU - Borad, Mitesh J.
AU - McWilliams, Robert R.
AU - Truty, Mark J.
N1 - Publisher Copyright:
© 2018
PY - 2018/4
Y1 - 2018/4
N2 - Background: Ideal oncologic management of gallbladder carcinoma (GBCA) after complete surgical resection is unclear. We sought to define benefit of post-resection adjuvant systemic chemotherapy alone in T2 or greater gallbladder carcinoma utilising a large national dataset. Study Design: The National Cancer Data Base (NCDB) 2004–2012 cohort was retrospectively reviewed for patients with GBCA (T2+) undergoing curative-intent resection and surviving at least 6 weeks. Univariate group comparisons, unadjusted Kaplan-Meier and adjusted Cox proportional hazards analyzed overall survival. Results: 4373 patients were included (N = 2479 T2, N = 1894 T3/4). Overall, 22.1% of patients received adjuvant chemotherapy. Use of multi-agent chemotherapy increased during the study period. Patients receiving adjuvant therapy were younger, had fewer comorbidities, more often node-positive and more likely R1-margins than those receiving surgery alone. Unadjusted overall survival was improved in all patients with node-positive disease as well as for those with inadequate nodal staging. The benefit of chemotherapy persisted after adjustment for patient and tumor factors. Conclusion: Adjuvant systemic chemotherapy is associated with survival benefit in patients with T2 or greater GBCA with node positive disease. We recommend a multidisciplinary approach in these patients as less than 1-in-4 of them currently receive adjuvant chemotherapy. Future clinical trials should address adjuvant chemotherapy in node positive GBCA.
AB - Background: Ideal oncologic management of gallbladder carcinoma (GBCA) after complete surgical resection is unclear. We sought to define benefit of post-resection adjuvant systemic chemotherapy alone in T2 or greater gallbladder carcinoma utilising a large national dataset. Study Design: The National Cancer Data Base (NCDB) 2004–2012 cohort was retrospectively reviewed for patients with GBCA (T2+) undergoing curative-intent resection and surviving at least 6 weeks. Univariate group comparisons, unadjusted Kaplan-Meier and adjusted Cox proportional hazards analyzed overall survival. Results: 4373 patients were included (N = 2479 T2, N = 1894 T3/4). Overall, 22.1% of patients received adjuvant chemotherapy. Use of multi-agent chemotherapy increased during the study period. Patients receiving adjuvant therapy were younger, had fewer comorbidities, more often node-positive and more likely R1-margins than those receiving surgery alone. Unadjusted overall survival was improved in all patients with node-positive disease as well as for those with inadequate nodal staging. The benefit of chemotherapy persisted after adjustment for patient and tumor factors. Conclusion: Adjuvant systemic chemotherapy is associated with survival benefit in patients with T2 or greater GBCA with node positive disease. We recommend a multidisciplinary approach in these patients as less than 1-in-4 of them currently receive adjuvant chemotherapy. Future clinical trials should address adjuvant chemotherapy in node positive GBCA.
KW - Adjuvant chemotherapy
KW - Gallbladder cancer
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U2 - 10.1016/j.ijsu.2018.02.052
DO - 10.1016/j.ijsu.2018.02.052
M3 - Article
C2 - 29496648
AN - SCOPUS:85042660370
SN - 1743-9191
VL - 52
SP - 171
EP - 179
JO - International Journal of Surgery
JF - International Journal of Surgery
ER -