Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) Database Analysis

Abstract

Background: T2 gallbladder cancer (GBC) is subdivided into T2a and T2b by the American Joint Committee on Cancer (AJCC) 8th edition. However; there is a lack of evidence for the prognostic significance of tumor location and validation with large-scale studies is needed. The aims of this study were to investigate the clinical features and clinical outcomes of T2 GBC according to tumor location and determine the prognostic significance of tumor location and an appropriate surgical strategy. Methods: Between 2000 and 2014 the Korea Tumor Registry System Biliary Pancreas (KOTUS-BP) database was used to identify and enroll a total 707 patients with pathologically diagnosed T2 GBC who underwent curative resection. Clinicopathological findings and long-term follow-up results were analyzed. Results: The incidence of lymph node metastasis in T2b was significantly higher than that of T2a tumors (37.9% vs. 29.5%, p = 0.032). The 5-year disease-specific survival of T2a was better than that of T2b tumors (74.8% vs. 65.4%, p = 0.019). There was no significant survival difference in T2a between extended cholecystectomy and simple cholecystectomy with lymph node dissection (81.8% vs. 73.7%, p = 0.361). However; there was a better survival trend for T2b tumor after extended cholecystectomy (71.7% vs. 59.3%, p = 0.057). Adjuvant chemotherapy was associated with improved survival for patients with lymph node metastasis in T2a (72.1% vs. 56.9; p = 0.022) and in T2b (68.2 vs. 48.5; p < 0.001). Multivariate analysis revealed that lymph node metastasis was the only significant poor prognostic factor (Hazard ratio 3.222; 95% confidential interval 1.960–4.489; p < 0.001). Conclusions: For T2 GBC; tumor location was not an independent prognostic factor. Lymph node metastasis was a significant poor prognostic factor and adjuvant chemotherapy should be considered for the patients with lymph node metastasis.

Textbook outcome in gallbladder carcinoma after curative-intent resection: a 10-year retrospective single-center study

“…Numerous studies have confirmed that ACT can significantly improve overall survival outcomes in patients with biliary tract malignancies with lymph node metastasis and positive surgical margins, consistent with our results. [32,33] However, ACT did not significantly improve the prognosis of patients who achieved a TO in this study.…”

“…Numerous studies have confirmed that ACT can significantly improve overall survival outcomes in patients with biliary tract malignancies with lymph node metastasis and positive surgical margins, consistent with our results. [32,33] However, ACT did not significantly improve the prognosis of patients who achieved a TO in this study. Ostwal et al [34] found that gemcitabine combined with cisplatin could improve the prognosis of stage IIIII GBC after radical resection without serious side effects, and patients tolerated this regimen well.…”

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis

“…In spite of its limited depth of invasion into the gallbladder wall, T2 GBC generally has a high rate of LN metastasis of up to 50% [ 9 , 19 , 20 , 21 ]. All the studies included in the present meta-analysis showed that LN metastasis was a significant prognostic factor in multivariate analysis, and they also demonstrated that a T2b tumor has a higher possibility of LN metastasis than a T2a tumor.…”

“…The gallbladder has a unique anatomy, and this anatomy might be associated with the tumor invasion, the mode of tumor spread and finally prognosis. The hepatic side of the gallbladder is attached directly to the liver only by loose connective tissue without serosa, and it has dense arterial, venous and lymphatic communications to allow easy invasion to the liver [ 9 ]. In contrast, the peritoneal side of the gallbladder is free from the adjacent organs.…”

Diagnostic Value of Serum D-Dimer for Detection of Gallbladder Carcinoma

“…The tumor stage of GBC was determined according to the American Cancer TNM Staging System Joint Committee (8th Edition) classification system. 8,9 T refers to the primary tumor stage, which is divided into Tis, T1a, T1b, T2a, T2b, T3, and T4 on account of the depth of tumor invasion. N refers to regional lymph node metastasis, which is divided into N0, N1, and N2.…”