E. A. De Savornin Lohman1, T. De Bitter2, R. Verhoeven3, I. Nagtegaal2, C. Van Laarhoven1, R. Van Der Post2, P. De Reuver1 1Radboudumc,Surgery,Nijmegen, Netherlands 2Radboudumc,Pathology,Nijmegen, Netherlands 3Netherlands Comprehensive Cancer Organization,Eindhoven, Netherlands
Introduction:
Gallbladder cancer (GBC) is a rare but lethal malignancy, primarily diagnosed in an advanced stage unless detected incidentally after laparoscopic cholecystectomy for benign gallbladder disease. Scarce data is available on GBC treatment and survival outcomes in Western populations. Consequently, controversy exists regarding surgical and systemic treatment. Using data from the Netherlands Cancer Registry, trends in incidence, treatment and survival of GBC patients were evaluated.
Methods:
Data of 2427 GBC patients diagnosed between 2000 – 2015 were included in this nationwide population-based study. Incidence and demographics were assessed. Treatment strategies and associated survival were analysed using Kaplan-Meier methods and propensity score matching.
Results:
Age-standardised incidence of GBC varied from 0.6 to 0.9 per 100.000 person years and did not change significantly over time. Demographic characteristics are presented in Table 1. Most tumours (67.2%) were detected pre-operatively. The overall median survival was 5.2 months and primarily determined by tumour stage, ranging from 36.2 months in stage I patients to 3.0 months in stage 4 patients. Between 2000 and 2015 median survival improved from 4.1 to 6.6 months (p < 0.01). After propensity score matching, median survival in surgically treated stage III + IV gallbladder cancer was 7.4 months, compared to 3.3 months for non-surgically treated patients (p < 0.001). Stage II GBC patients receiving additional liver bed resection showed superior median survival to those whom did not receive additional surgery (21.7 vs. 46.6 months, p < 0.001). Systemic therapy in advanced stage GBC improved median survival from 2.8 to 7.4 months.
Conclusion:
Although an increase of 2 months in overall survival was demonstrated over time, the clinical significance of this finding is debatable and outcome of GBC patients is still poor. A considerable, clinically relevant increase in survival was seen in two subgroups: patients with early GBC receiving additional resection and patients with advanced GBC treated with systemic therapy. More aggressive treatment strategies should be advocated, as they appear to improve the prospects of GBC patients.
