Systemic Chemotherapy Combined with Resection for Locally Advanced Gallbladder Carcinoma: Surgical and Survival Outcomes

Abstract

Background Preoperative chemotherapy is a strategy for conversion to resection and/or assessing disease biology prior to operation. The utility of such an approach in gallbladder carcinoma (GBCA) is unknown. This study evaluates outcomes of GBCA patients treated with chemotherapy for locally advanced or lymph node involved tumors. Study Design Patients that received systemic chemotherapy for locally advanced or lymph node positive GBCA were identified from a departmental database. Patients were excluded if there was any evidence of distant metastases or if records were inadequate to determine initial chemotherapy and response. Response (RECIST), operative results, and overall survival (OS) were assessed. Results Seventy-four patients were included from 1992–2015. Eighty-nine percent of patients (n=64) were treated with gemcitabine and 57% with gemcitabine/platinum (n=42). At initial response assessment, 17 patients (23%) had progression. The remaining patients had stable disease (n=38, 51%) or partial response (n=19, 26%). Twenty-two patients (30%) underwent attempt at resection which was definitive for 10 patients (14%). Median OS for the entire cohort was 14 months (95% CI:11.3–17.9). Among patients with surgery, definitive resection was associated with a median OS of 51 months (95% CI:11.7–55.3) compared to 11 months (95% CI:4.1–23.6) for those that were unresectable (p=0.003). Conclusions Even without distant metastases, locally advanced or lymph node positive GBCA is associated with poor outcomes. Definitive resection was possible in a subset of patients selected for surgery after a favorable response to chemotherapy and was associated with long-term survival. We recommend surgical re-evaluation following chemotherapy to select potential operative candidates.

Outcome of neoadjuvant chemotherapy in “locally advanced/borderline resectable” gallbladder cancer: the need to define indications

“…Similar study from MSKCC group in 74 locally advanced GBC patients reported significantly improved median OS of 51 months for 10 patients who HPB underwent definitive resection after NACT and 14 months for the entire cohort. 21 Chemotherapy provided a significant survival benefit even in a group of patients with unresectable SD post NACT proving that benefit of chemotherapy was sustained across all groups. CA 19.9 levels and liver infiltration were significant only on univariate analysis.…”

Outcomes of surgical resection of gallbladder cancer in patients presenting with jaundice: A systematic review and meta‐analysis

“…Sirohi et al reported a 65% response rate with a 40% R0 resection rates in patients with Gem‐CIs/Gem‐Ox neoadjuvant chemotherapy for locally advanced patients with GBC. Creasy et al from Memorial Sloan Kettering Cancer center reported a 14% curative resection rate with a significantly improved overall survival in the resection group (51 months [95% CI, 11.7‐55.3] vs 11 months [95% CI, 4.1‐23.6] P = 0.003). Both these studies included all the patients with locally advanced GBC and not exclusively those with jaundice.…”

Biliary Tract Cancer at CT: A Radiomics-based Model to Predict Lymph Node Metastasis and Survival Outcomes

“…Because LN positivity is comparable between the primary and validation cohorts, our results suggest that the aggressiveness of BTCs. Neoadjuvant therapy may be indicated for tumors with high risk of LN metastasis to evaluate tumor biology and defined patient subsets most likely to benefit from surgical treatment (30,31).…”