Adjuvant systemic therapy after resection of node positive gallbladder cancer: Time for a well-designed trial? (Results of a US-national retrospective cohort study)

John R. Bergquist, Harsh N. Shah, Elizabeth B. Habermann, Matthew C. Hernandez, Tommy Ivanics, Michael L. Kendrick, Rory L. Smoot, David M. Nagorney, Mitesh J. Borad, Robert R. McWilliams, Mark J. Truty

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)171-179
Number of pages9
JournalInternational Journal of Surgery
Volume52
DOIs
StatePublished - Apr 2018

Keywords

  • Adjuvant chemotherapy
  • Gallbladder cancer

ASJC Scopus subject areas

  • Surgery

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