Trends in Treatment and Survival of Gallbladder Cancer in the Netherlands; Identifying Gaps and Opportunities from a Nation-Wide Cohort

Abstract

Gallbladder cancer (GBC) is rare in Western populations and data about treatment and outcomes are scarce. This study aims to analyze survival and identify opportunities for improvement using population-based data from a low-incidence country. GBC patients diagnosed between 2005 and 2016 with GBC were identified from the Netherlands Cancer Registry. Patients were grouped according to time period (2005–2009/2010–2016) and disease stage. Trends in treatment and overall survival (OS) were analyzed. In total 1834 patients were included: 661 (36%) patients with resected, 278 (15%) with non-resected non-metastatic, and 895 (49%) with metastatic GBC. Use of radical versus simple cholecystectomy (12% vs. 26%, p < 0.001) in early (pT1b/T2) GBC increased. More patients with metastatic GBC received chemotherapy (11% vs. 29%, p < 0.001). OS improved from 4.8 months (2005–2009) to 6.1 months (2010–2016) (p = 0.012). Median OS increased over time (2005–2009 vs. 2010–2016) in resected (19.4 to 26.8 months, p = 0.038) and metastatic (2.3 vs. 3.4 months, p = 0.001) GBC but not in unresected, non-metastatic GBC. In early GBC, patients with radical cholecystectomy had a median OS of 76.7 compared to 18.4 months for simple cholecystectomy (p < 0.001). Palliative chemotherapy showed superior (p < 0.001) survival in metastatic (7.3 versus 2.1 months) and non-resected non-metastatic (7.7 versus 3.5 months) GBC. In conclusion, survival of GBC remains poor. Radical surgery and palliative chemotherapy appear to improve prognosis but remain under-utilized.

Gallbladder cancer epidemiology, treatment and survival in Southern Finland – a population-based study

“…However, the rate of curative-intent surgery did not change during the study period, similarly as reported in a Swedish population-based study [29]. Patients' overall rate of proceeding to curativeintent surgery in our study was 19%, which is lower than the resection rate reported in West Sweden (37%), Netherlands (36%) or in Ontario (46%) [29,30,38]. Differences in curativeintent resection rates might reflect an actual difference in aggressiveness to surgical treatment but may also be explained by differences in defining curative-intent resection.…”

“…Although most of the literature on GBC is based on single-center retrospective series, a few population-based reports are available such as from Netherlands and West Sweden [28][29][30]. These epidemiological studies have shown a change in treatment patterns during a few last decades, but the survival remains largely unchanged [28,29].…”

Diagnostic performance of preoperative CT in differentiating between benign and malignant origin of suspicious gallbladder lesions

“…At present, overall 5-year survival rates are up to 13 % [4,5]. This poor prognosis is due to the unfavorable anatomical position of the gallbladder and non-specific symptoms, which make it difficult to diagnose clinically [6].…”

“…This poor prognosis is due to the unfavorable anatomical position of the gallbladder and non-specific symptoms, which make it difficult to diagnose clinically [6]. Only in patients with T1b/T2 tumors undergoing radical resection, long-term survival has been reported, with a 5-year survival rate of 53 % [5]. However, in the majority of cases, GBC is found at an advanced stage, when surgery is no option anymore [7].…”

Quality-of-Life Assessment in Patients Receiving Palliative Chemotherapy: Call for Action

“…Management of advanced, unresectable gastrointestinal cancers with palliative chemotherapy (PC) is a common and widely accepted oncologic practice as it is associated with modest survival benefit. [1][2][3] In addition to survival gain, the key objectives of PC should also be to improve symptoms and preserve quality of life (QOL). In a shared decision-making model, data regarding the impact of PC on symptom improvement and maintenance of QOL will greatly influence patients' decision regarding PC.…”