Analysis of Prognostic Factors Affecting Survival in Patients with Gallbladder Cancer

ABSTRACT

PURPOSE: Recent findings indicate that after cholecystectomy for early gallbladder cancer (GBC), outcomes are generally satisfactory. But outcomes for advanced GBC are dismal, even with recent advances in diagnostic and therapeutic modalities. The purpose of this study was to evaluate surgical outcomes and prognostic factors affecting survival after surgical resection in patients with GBC. METHODS: We retrospectively reviewed clinical data from 133 patients with GBC who underwent surgical resection between January 2000 and December 2008. Their clinical condition, surgical treatment, and pathologic factors were analyzed. RESULTS: Among the 133 patients with GBC, curative resection was achieved in 95 (71.4%). The 5-year survival rate in patients who underwent curative resection (52.6%) was much better than in those who underwent palliative resection (0.0%, p<0.000). Univariate analysis revealed that the following factors were associated with patient survival preoperative jaundice, pain at presentation, incidental GBC, serum total bilirubin, alkaline phosphatase (ALP), carbohydrate antigen 19-9 levels, curability, lymph node (LN) dissection, size, site, macroscopic type of tumor, histologic differentiation, the depth of tumor invasion (T stage), LN metastasis, TNM stage and microscopic perineural invasion. Multivariate analysis revealed that the following were independent, favorable prognostic factors curative resection, no LN metastasis, low TNM stage, non-papillary macroscopic type, and low ALP levels. CONCLUSION: Complete tumor resection and no LN metastasis are important prognostic factors for GBC. Favorable survival outcomes can be achieved when curative resection is done in early stage GBC and when operative procedures are planned with the consideration of the survival benefit of surgery in advanced GBC.