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Adjuvant Chemotherapy in Resectable Gallbladder Cancer is Underutilized Despite Benefits in Node-Positive Patients

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Adjuvant chemotherapy (AC) is recommended following surgical resection of gallbladder cancer regardless of stage. However, stage-specific benefits of AC in gallbladder cancer are unclear.

Patients and Methods

Patients with resected pathologic stage I–III gallbladder cancer were identified using the 2006–2015 National Cancer Database. Utilization trends, predictors of use, and impact of AC on overall survival (OS) were determined.

Results

A total of 5656 patients were included. Use of AC increased from 9.9% in 2006 to 24.2% in 2015 (OR 2.91; 95% CI 2.06–4.09; p < 0.001). However, only 17.5% of patients overall and only 32.4% of node-positive (stage IIIb) patients received AC. Patients receiving AC were younger and had fewer comorbidities, shorter hospitalizations, more advanced disease, and more margin-positive resections (all p < 0.01). Higher pathologic T stage and positive nodal status represented the greatest independent predictors of receipt of AC. While AC demonstrated no OS advantage for stage I patients (p = 0.83), AC was associated with improved OS among stage II patients (p = 0.003), though this impact was not independently associated with improved OS on multivariable analysis. AC was independently associated with improved OS among stage IIIb patients, with a 30% reduction in risk of death (HR 0.70; 95% CI 0.58–0.83; p < 0.001). Younger age, fewer comorbidities, and shorter hospitalization all predicted receipt of AC among stage IIIb patients (all p < 0.05).

Conclusions

Systemic therapy remains underprescribed, in particular among patients that would seem to benefit most. Adjuvant chemotherapy likely improves survival in node-positive gallbladder cancer, but its utility in the treatment of node-negative disease has not been demonstrated.

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Authors and Affiliations

  1. Department of Surgery, Brooke Army Medical Center, Houston, TX, USA

    Phillip M. Kemp Bohan MD, Robert C. Chick MD, G. Travis Clifton MD, FACS & Timothy J. Vreeland MD, FACS

  2. Department of Surgery, William Beaumont Army Medical Center, El Paso, TX, USA

    Derek T. Kirby DO & Daniel W. Nelson DO

  3. Department of Clinical Investigation, William Beaumont Army Medical Center, El Paso, TX, USA

    Julia O. Bader PhD

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  1. Phillip M. Kemp Bohan MD
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  2. Derek T. Kirby DO
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  3. Robert C. Chick MD
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  4. Julia O. Bader PhD
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  5. G. Travis Clifton MD, FACS
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  6. Timothy J. Vreeland MD, FACS
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Contributions

Dr. Kemp Bohan and Dr. Kirby are cofirst authors and contributed equally to the work. All authors have made substantial contributions to the conception and design of the work; acquisition, analysis, and interpretation of data for the work; drafting the work or providing critical revisions; and all approved of the final version to be published. All authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Daniel W. Nelson DO.

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The authors have no conflicts of interest to declare. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Kemp Bohan, P.M., Kirby, D.T., Chick, R.C. et al. Adjuvant Chemotherapy in Resectable Gallbladder Cancer is Underutilized Despite Benefits in Node-Positive Patients. Ann Surg Oncol 28, 1466–1480 (2021). https://doi.org/10.1245/s10434-020-08973-x

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  • DOI: https://doi.org/10.1245/s10434-020-08973-x

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