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Patkar S, Kunte A, Varty GP, Ramaswamy A, Bhargava P, Ostwal V, Goel M. Comparison of age-stratified survival outcomes of gallbladder cancers in an Indian population. HPB (Oxford) 2024:S1365-182X(24)01737-4. [PMID: 38834414 DOI: 10.1016/j.hpb.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/15/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Gallbladder cancers (GBCs) occur a decade earlier in India in comparison to the global occurrence, limiting the applicability of existing literature on age adjusted outcomes. METHODS Patients who underwent surgery between 01.01.2010 and 31.12.2020 for GBC were analyzed. Patients were divided into three age groups: group 1(≤40 years), group 2(41-60 years), group 3(>60 years) and their outcomes were compared. RESULTS Total of 6190 patients were treated for suspected or diagnosed GBC with a median age of 57 years. Curative resection was performed in 749 (67.9%) patients, of whom 114 (16.2%), 471 (62.9%), and 164 (21.9%) patients were in groups 1, 2, and 3, respectively. 5-year disease-free survival (DFS) [46.8% vs. 58.5%, p = 0.031] and overall survival (OS)[53.5% vs. 66.6%, p = 0.05] of group 3 were significantly lower than group 1. Patient age (HR 1.021), AJCC stage (HR 6.413), pathologic residual disease in the gallbladder fossa (HR 2.44), and extranodal tumor deposits (HR 1.762) were identified as independent predictors of poor OS. CONCLUSIONS Gallbladder cancers in the Indian population show poorer outcomes with advancing age. Higher proportion of males in the elderly group with a more advanced stage at presentation are plausible reasons for poorer outcomes.
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Affiliation(s)
- Shraddha Patkar
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aditya Kunte
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gurudutt P Varty
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Prabhat Bhargava
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mahesh Goel
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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Wen C, Tang J, Wang T, Luo H. A nomogram for predicting cancer-specific survival for elderly patients with gallbladder cancer. BMC Gastroenterol 2022; 22:444. [PMID: 36324087 PMCID: PMC9632126 DOI: 10.1186/s12876-022-02544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
Background Gallbladder cancer (GBC) is a highly aggressive malignancy in elderly patients. Our goal is aimed to construct a novel nomogram to predict cancer-specific survival (CSS) in elderly GBC patients. Method We extracted clinicopathological data of elderly GBC patients from the SEER database. We used univariate and multivariate Cox proportional hazard regression analysis to select the independent risk factors of elderly GBC patients. These risk factors were subsequently integrated to construct a predictive nomogram model. C-index, calibration curve, and area under the receiver operating curve (AUC) were used to validate the accuracy and discrimination of the predictive nomogram model. A decision analysis curve (DCA) was used to evaluate the clinical value of the nomogram. Result A total of 4241 elderly GBC patients were enrolled. We randomly divided patients from 2004 to 2015 into training cohort (n = 2237) and validation cohort (n = 1000), and patients from 2016 to 2018 as external validation cohort (n = 1004). Univariate and multivariate Cox proportional hazard regression analysis found that age, tumor histological grade, TNM stage, surgical method, chemotherapy, and tumor size were independent risk factors for the prognosis of elderly GBC patients. All independent risk factors selected were integrated into the nomogram to predict cancer-specific survival at 1-, 3-, and 5- years. In the training cohort, internal validation cohort, and external validation cohort, the C-index of the nomogram was 0.763, 0.756, and 0.786, respectively. The calibration curves suggested that the predicted value of the nomogram is highly consistent with the actual observed value. AUC also showed the high authenticity of the prediction model. DCA manifested that the nomogram model had better prediction ability than the conventional TNM staging system. Conclusion We constructed a predictive nomogram model to predict CSS in elderly GBC patients by integrating independent risk factors. With relatively high accuracy and reliability, the nomogram can help clinicians predict the prognosis of patients and make more rational clinical decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02544-y.
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Affiliation(s)
- Chong Wen
- General Surgery Center, The General Hospital of Western Theater, Chengdu, 610083, Sichuan Province, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Jie Tang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenyang Medical College, Shenyang, China
| | - Tao Wang
- General Surgery Center, The General Hospital of Western Theater, Chengdu, 610083, Sichuan Province, China.
| | - Hao Luo
- General Surgery Center, The General Hospital of Western Theater, Chengdu, 610083, Sichuan Province, China.
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Akbar N, Yaseen T, Muhammad A, Danish M, Adeel M, Khan SA, Ismail H, Bajaj K, Ali I, Panezai MQ, Tareen M, Tasneem AA, Laeeq SM, Hanif F, Luck NH. A Tertiary Care Center\'s Experience with Clinicopathological Characteristics of Gallbladder Carcinoma in Our Population. Euroasian J Hepatogastroenterol 2022; 12:35-39. [PMID: 35990861 PMCID: PMC9357526 DOI: 10.5005/jp-journals-10018-1375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Gallbladder cancer (GBC) is the most common malignant biliary tract tumor with the shortest survival from the time of diagnosis. This poor prognosis is due to the destructive biologic behavior of GBC, lack of sensitive screening tests for early detection, and vague nature of first presentation. Here in this study, we will evaluate the baseline characteristics of the patients presenting with gallbladder carcinoma in our population. Materials and methods This retrospective study was conducted in the Department of Gastroenterology at Sindh Institute of Urology and Transplantation (SIUT), Karachi. Patient data were compiled and composed from the in-patient health records, radiology, and operational records. Those patients with suspicion of GBC, but negative at histology, or patients having inconclusive radiologic findings, were excluded. Baseline characteristics were recorded. Results were presented as means ± SD for quantitative data or as numbers with percentages for qualitative data. Continuous variables were analyzed using the Student's t-test, while categorical variables were analyzed using the Chi-square test. A p-value of <0.05 was considered statistically significant. Results A total of 162 patients were included in our study. Among them, 101 (62.3%) were females. Hypertension was the most common comorbid illness noted in 29 (17.9%) patients while 91 (56.2%) patients had no concurrent comorbidities. Most common risk factor for carcinoma of gallbladder was gallstones seen in 106 (65.1%) patients. The most common presenting complaint was combination of obstructive jaundice, weight loss with right hypochondrial pain seen in 66 (40.7%) patients. On CT abdomen, direct liver infiltration without lymphovascular invasion was noted in 77 (47.5%) patients followed by liver infiltration along with lymphovascular invasion in 26 (16%) patients and distant metastasis in 24 (14.8%) patients. On gallbladder (GB) mass biopsy, 58 (35.8%) patients had well-differentiated, 46 (28.4%) had moderately differentiated, while 33 (20.4%) had poorly differentiated adenocarcinoma. Of 162 patients, 103 (63.6%) patients underwent endoscopic retrograde cholangiopancreatography (ERCP). The most common finding on ERCP was proximal common bile duct (CBD) stricture with intrahepatic biliary system dilatation which was noted in 95 (58.6%) patients. Percutaneous transhepatic cholangiography (PTC) was performed only in 9 (5.6%) patients. Seventeen (10.5%) patients were managed by simple cholecystectomy, 39 (24.1%) patients underwent extended cholecystectomy, 14 (8.6%) patients underwent chemotherapy, while 102 (56.8%) patients were given palliative management. When followed for 1 year, 101 (62.3%) patients died within 6 months. Conclusion The baseline characteristics, biopsy findings, modes of treatment, and rates of 1 year mortality were studied in patients with gallbladder carcinoma in our population. Advanced age, high white blood cell counts, and serum bilirubin at presentation with low lymphocyte count and presence of comorbid illnesses were the factors independently associated with increased mortality in patients with gallbladder carcinoma. However, further studies with large sample size and stratification with respect to age, gender, and different variables can be done in terms of mortality in patients with gallbladder carcinoma. How to cite this article Akbar N, Yaseen T, Muhammad A, et al. A Tertiary Care Center's Experience with Clinicopathological Characteristics of Gallbladder Carcinoma in Our Population. Euroasian J Hepato-Gastroenterol 2022;12(1):35–39.
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Affiliation(s)
- Nishat Akbar
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Taha Yaseen
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
- Taha Yaseen, Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan, e-mail:
| | - Arz Muhammad
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Muhammad Danish
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Muhammad Adeel
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Shoaib A Khan
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Hina Ismail
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Kiran Bajaj
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Imdad Ali
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Muhammad Q Panezai
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Munir Tareen
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Abbas A Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Syed M Laeeq
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Farina Hanif
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
| | - Nasir H Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Sindh, Pakistan
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