Who benefits from R0 resection? A single-center analysis of patients with stage Ⅳ gallbladder cancer

Comparison of treatment models for single primary advanced gallbladder cancer

Purpose

Treatment for advanced gallbladder cancer (GBC) remains controversial, with various recommendations regarding the choice and combination of surgery and adjuvant therapy. The present article is targeting for the exploration of optimal treatment models for advanced GBC.

Methods

AJCC (American Joint Committee on Cancer, 8th edition) stage III and stage IV GBC, were defined as advanced GBC. Patients with advanced GBC were identified using the Surveillance, Epidemiology, and End Results (SEER) database and departmental cohort. Because of the most representative, only gallbladder adenocarcinoma (GBAC) patients were selected. Based on their surgical status (No, Non-radical and Radical surgery), chemotherapy status (Chemotherapy, No chemotherapy), and radiotherapy status (Radiotherapy, No radiotherapy), treatment models were categorized. For the purposes of evaluating the treatment outcomes of various treatment models and determining the risk element for cancer-specific survival (CSS), Cox regression analysis was applied. Kaplan-Meier curves were used before and after adjusting for covariates, with log-rank tests used to analyze discrepancies between curves. Immunotherapy was analyzed using clinical data from departmental cohort. Finally, to compensate for the limitations of the database, a review examines the progress in treatment models for advanced GBC.

Results

5,154 patients aged over 18 years with solitary primary advanced GBC were identified from the SEER database. In advanced GBC patients, the treatment model has emerged as a significant prognostic factor. "Radical surgery + Chemotherapy + Radiotherapy" models maximally improved the CSS of advanced GBC before and after adjusting for covariates, while "No surgery + No chemotherapy + No radiotherapy" model had the lowest CSS. The present conclusions were supported even after subgroup analysis by AJCC stage. The efficacy of immunotherapy was demonstrated in the departmental cohort analysis. Additionally, this article provides a comprehensive overview of recent advancements in various emerging treatment strategies.

Conclusion

Even when optimal treatment model cannot be pursued, providing comprehensive combinations of treatments to advanced GBC patients whenever possible is always beneficial for their survival.

Surgery versus no surgery in stage IV gallbladder carcinoma: A propensity score-matched analysis

Objectives

Patients with stage IV gallbladder cancer (GBC) have a dismal prognosis. Mostly, they are not amenable to surgical treatment. However, in some of them, a potentially curative surgical resection is possible. There is paucity of the literature comparing survival of patients with surgically resectable stage IV GBC to the patients with unresectable stage IV GBC.

Material and Methods

This retrospective study was conducted on patients with AJCC stage IV GBC who were managed by a surgical unit at a tertiary care center from May 2009 to March 2021. Patients were grouped into either surgery group (cases) or no surgery group (control). Cases were compared to controls for demographic characteristics, clinical parameters, and survival rates. A comparison was made in both unmatched and matched (propensity score matching 1:1 with covariates age, gender, ECOG, chemotherapy, and TNM staging) groups.

Results

The total number of patients with stage IV GBS was 120, out of that, 29 were cases, and 91 were controls. After matching, each group had 28 cases (28 + 28= 56). Post-matching AJCC stage, chemotherapy, and other parameters were equally distributed between the groups (p= 1.00). However, cases had more patients with N2 metastasis (p <0.001), and controls had more patients with distant metastasis (p <0.001). Cases vs. controls, overall survival before matching was 22 vs. seven months (p= 0.001) and after matching was 22 vs. 11 months (p= 0.005).

Conclusion

Patients with stage IV GBC amenable to potentially curative surgical resection (R0) have significantly better survival than patients with non-surgical treatment. Therefore, it may be more appropriate to classify these group differently.