Therapeutic outcomes and prognostic factors in unresectable gallbladder cancer treated with gemcitabine plus cisplatin

Abstract

BackgroundGallbladder cancer (GBC) is likely to be diagnosed at progressive stages and shows a very poor prognosis. Combination therapy with gemcitabine and cisplatin (GEMCIS) has been widely used as first-line palliative chemotherapy for advanced GBC. This study was designed to investigate the efficacy of GEMCIS and identify prognostic factors in patients with unresectable GBC.MethodsPatients with GBC who were treated with GEMCIS from January 2008 to June 2017 in a single tertiary hospital were included. All cases of GBC were diagnosed by pathologic findings and extent of the tumour was assessed by imaging tests. Combination chemotherapy consisted of cisplatin 25 mg/m2 and gemcitabine 1000 mg/m2 intravenously on days 1 and 8 every 3 weeks. To determine factors affecting prognosis, Kaplan–Meier survival analysis, log-rank test and the Cox proportional hazard regression linear model were used. All variables with P < 0.1 in univariable analysis were included in the multivariable model.ResultsA total of 173 patients received a median of 5.3 ± 4.4 cycles of chemotherapy over 3.8 ± 3.9 months. Most of the patients (94.8%) were stage IVB at the time of diagnosis and the most common site of metastasis was the liver (42.8%). Disease control rate was 59.5%: 2 (1.2%) patients with complete response, 26 (15.0%) patients with partial response and 75 (43.4%) patients with stable disease. Overall survival (OS) and progression-free survival were 8.1 (95% confidence interval [CI], 7.1–10.2) and 5.6 (95% CI 4.5–6.8) months, respectively. Multivariable regression model indicated that metastasis to liver (hazard ratio [HR] = 1.63, 95% CI 1.11–2.40; P = 0.013), neutrophil-to-lymphocyte ratio (NLR) ≥3 (HR 1.65, 95% CI 1.09–2.49; P = 0.017), CEA ≥ 5 ng/mL (HR 1.50, 95% CI 1.02–2.19; P = 0.038), and CA19–9 ≥ 500 U/mL (HR 1.59, 95% CI 1.01–2.50; P = 0.043) were significantly associated with OS.ConclusionsGEMCIS demonstrated a high disease control rate in patients with unresectable GBC. Factors independently related to OS were metastasis to liver, NLR ≥ 3, CEA ≥ 5 ng/mL and CA19–9 ≥ 500 U/mL.

Prognostic Value of Peripheral Whole Blood Cell Counts Derived Indexes in Gallbladder Carcinoma: A Systematic Review and Meta-Analysis

“…After removal of duplicates, we browsed the titles and abstracts of the remaining 134 studies, and 107 studies were excluded according to the inclusion and exclusion criteria. Then we assessed full-text review of the remaining 27 studies, another 13 studies were excluded and finally 14 retrospective cohort studies were included for meta-analysis (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Basic characteristics of included studies were listed in Table 1.…”

“…Eight studies incorporating 1,325 patients investigated prognostic value of PLR in GBC patients ( 11 , 14 – 18 , 20 , 21 ). No significant heterogeneity between groups was observed (I 2 = 33.4%, P = 0.162), and the pooled HR showed that low PLR group had significant better OS than high PLR group ( Figure 4 , HR = 1.34, 95% CI = 1.14–1.57, P < 0.001).…”

“…Despite the robust and growing data regarding the utility of these WBCC-derived indexes, findings are not uniform across all publications. Furthermore, previous studies mainly focused on colorectal, pancreatic, prostate, lung, esophageal-gastric and breast cancers (7), only few studies conducted investigations on GBC until recently (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Based on the available data, we aimed to systematically review and rationalize the evidence for the prognostic value of these WBCC-derived indexes in predicting outcomes of GBC patients.…”

Current and New Biomarkers for Early Detection, Prognostic Stratification, and Management of Gallbladder Cancer Patients

“…Multiple studies have explored potential clinical factors associated with outcome to first-line CisGem [135][136][137][138]. Within the identified factors, poor performance status, elevated serum lactate dehydrogenase, elevated neutrophil-to-lymphocyte ratio, low hemoglobin, metastatic disease, increased bilirubin, increased neutrophils, and high baseline tumor markers were associated with poor outcome [136][137][138]. In addition, reduction in CA 19-9 during therapy predicted longer patient survival [135].…”

Metastatic gallbladder carcinoma presenting as an ovarian mass

“…Moreover, chemotherapy regimens for both are different. 10,11 For unresectable gallbladder carcinomas, the preferred regimen is Gemcitabine based while Platinum-based regimens are preferred for advanced Ovarian carcinomas. [10][11][12]…”