Skip to main content

Advertisement

SpringerLink
Log in

Key Factors Influencing Prognosis in Relation to Gallbladder Cancer

  • Review
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

Introduction

The 5-year survival of patients with gallbladder cancer remains low. However, patients can be stratified into prognostic categories based on established factors such as T, N, and R status. New concepts regarding prognostic significance of lymph node disease, the importance of residual gallbladder fossa disease, and the gravity of presentation with jaundice are reviewed. In addition, a number of new prognostic factors proposed in recent years are considered.

Methods

PubMed was searched for “gallbladder cancer” with builder “date-completion” 2008 to present. A total of 1,490 articles were screened from which 168 were retrieved. From this, 40 articles specifically related to prognosis form the basis for this review.

Discussion

Key factors of prognostic significance remain T and N stage and R0 resection. Residual disease either in the gallbladder fossa, lymph nodes, or cystic duct margin dictates hepatectomy, lymphadenectomy and bile duct resection, respectively. Adequate lymphadenectomy requires removal of six nodes, and hepatectomy must be sufficient to achieve R0. Subtleties regarding lymph node ratio, significance of pathological features such as dedifferentiation, and budding may hold value for stratifying patients with early stage disease, but require further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Butte JM, Matsuo K, Gonen M, et al. Gallbladder cancer: differences in presentation, surgical treatment, and survival in patients treated at centers in three countries. J Am Coll Surg. 2011;212:50–61.

    Article  PubMed  Google Scholar 

  2. Edge SB, American Joint Committee on Cancer, American Cancer Society. AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual. New York: Springer; 2010.

  3. Benson AB, Abrams TA, Ben-Josef E, et al. NCCN Clinical Practice Guidelines in Oncology: Hepatobiliary Cancers. Version 2.2012. Available at: http://www.nccn.org/professionals/physician_gls/pdf/hepatobiliary.pdf. Accessed 1 March 2013.

  4. Greene FL, American Joint Committee on Cancer, American Cancer Society. AJCC Cancer Staging Handbook: From the AJCC Cancer Staging Manual. New York: Springer; 2002.

  5. House MG, Gonen M, Jarnagin WR, et al. Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg. 2007;11:1549–1555.

    Article  PubMed  Google Scholar 

  6. Pawlik TM, Gleisner AL, Cameron JL, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 2007;141:610–618.

    Article  PubMed  Google Scholar 

  7. Ito H, Ito K, D’Angelica M, et al. Accurate staging for gallbladder cancer: implications for surgical therapy and pathological assessment. Ann Surg. 2011;254:320–325.

    Article  PubMed  Google Scholar 

  8. Negi SS, Singh A, Chaudhary A. Lymph nodal involvement as prognostic factor in gallbladder cancer: location, count or ratio? J Gastrointest Surg. 2011;15:1017–1025.

    Article  PubMed  Google Scholar 

  9. Shirai Y, Sakata J, Wakai T, et al. Assessment of lymph node status in gallbladder cancer: location, number, or ratio of positive nodes. World J Surg Oncol. 2012;10:87.

    Article  PubMed  Google Scholar 

  10. Mayo SC, Shore AD, Nathan H, et al. National trends in the management and survival of surgically managed gallbladder adenocarcinoma over 15 years: a population-based analysis. J Gastrointest Surg. 2010;14:1578–1591.

    Article  PubMed  Google Scholar 

  11. Downing SR, Cadogan KA, Ortega G, et al. Early-stage gallbladder cancer in the surveillance, epidemiology, and end results database: effect of extended surgical resection. Arch Surg. 2011;146:734–738.

    Article  PubMed  Google Scholar 

  12. Sakata J, Shirai Y, Wakai T, et al. Number of positive lymph nodes independently determines the prognosis after resection in patients with gallbladder carcinoma. Ann Surg Oncol. 2010;17:1831–1840.

    Article  PubMed  Google Scholar 

  13. Sasaki E, Nagino M, Ebata T, et al. Immunohistochemically demonstrated lymph node micrometastasis and prognosis in patients with gallbladder carcinoma. Ann Surg. 2006;244:99–105.

    Article  PubMed  Google Scholar 

  14. Tanabe M, Endo I, Masunari H, et al. Is lymph-node micrometastasis in gallbladder cancer a significant prognostic factor? Hepatogastroenterology. 2012;59:31–35.

    PubMed  Google Scholar 

  15. Bartlett DL, Fong Y, Fortner JG, et al. Long-term results after resection for gallbladder cancer. Implications for staging and management. Ann Surg. 1996;224:639–646.

    Article  PubMed  CAS  Google Scholar 

  16. Lowe K, Khithani A, Mejia A, et al. All lymph node positive patients are not equal: a new paradigm in gallbladder cancer. Am Surg. 2012;78:147–148.

    PubMed  Google Scholar 

  17. Jensen EH, Abraham A, Jarosek S, et al. Lymph node evaluation is associated with improved survival after surgery for early stage gallbladder cancer. Surgery. 2009;146:706–711; discussion 711–703.

    Google Scholar 

  18. Ito H, Matros E, Brooks DC, et al. Treatment outcomes associated with surgery for gallbladder cancer: a 20-year experience. J Gastrointest Surg. 2004;8:183–190.

    Article  PubMed  Google Scholar 

  19. Aramaki M, Matsumoto T, Shibata K, et al. Factors influencing recurrence after surgical treatment for T2 gallbladder carcinoma. Hepatogastroenterology. 2004;51:1609–1611.

    PubMed  Google Scholar 

  20. de Aretxabala X, Roa I, Hepp J, et al. Early gallbladder cancer: is further treatment necessary? J Surg Oncol. 2009;100:589–593.

    Article  PubMed  Google Scholar 

  21. Lendoire JC, Gil L, Duek F, et al. Relevance of residual disease after liver resection for incidental gallbladder cancer. HPB (Oxford). 2012;14:548–553.

    Article  Google Scholar 

  22. Fetzner UK, Holscher AH, Stippel DL. Regional lymphadenectomy strongly recommended in T1b gallbladder cancer. World J Gastroenterol. 2011;17:4347–4348.

    Article  PubMed  Google Scholar 

  23. Pawlik TM, Gleisner AL, Vigano L, et al. Incidence of finding residual disease for incidental gallbladder carcinoma: implications for re-resection. J Gastrointest Surg. 2007;11:1478–1486; discussion 1486–1477.

    Google Scholar 

  24. Choi SB, Han HJ, Kim CY, et al. Surgical outcomes and prognostic factors for T2 gallbladder cancer following surgical resection. J Gastrointest Surg. 2010;14:668–678.

    Article  PubMed  Google Scholar 

  25. Chakravarty KD, Yeh CN, Jan YY, Chen MF. Factors influencing long-term survival in patients with T3 gallbladder adenocarcinoma. Digestion. 2009;79:151–157.

    Article  PubMed  CAS  Google Scholar 

  26. Nakata T, Kobayashi A, Miwa S, et al. Impact of tumor spread to the cystic duct on the prognosis of patients with gallbladder carcinoma. World J Surg. 2007;31:155–161; discussion 162–153.

    Google Scholar 

  27. Pawlik TM, Choti MA. Biology dictates prognosis following resection of gallbladder carcinoma: sometimes less is more. Ann Surg Oncol. 2009;16:787–788.

    Article  PubMed  Google Scholar 

  28. Araida T, Higuchi R, Hamano M, et al. Should the extrahepatic bile duct be resected or preserved in R0 radical surgery for advanced gallbladder carcinoma? Results of a Japanese Society of Biliary Surgery Survey: a multicenter study. Surg Today. 2009;39:770–779.

    Article  PubMed  Google Scholar 

  29. Bickenbach KA, Shia J, Klimstra DS, et al. High-grade dysplasia of the cystic duct margin in the absence of malignancy after cholecystectomy. HPB (Oxford). 2011;13:865–868.

    Article  Google Scholar 

  30. Hawkins WG, DeMatteo RP, Jarnagin WR, et al. Jaundice predicts advanced disease and early mortality in patients with gallbladder cancer. Ann Surg Oncol. 2004;11:310–315.

    Article  PubMed  Google Scholar 

  31. Regimbeau JM, Fuks D, Bachellier P, et al. Prognostic value of jaundice in patients with gallbladder cancer by the AFC-GBC-2009 study group. Eur J Surg Oncol. 2011;37:505–512.

    Article  PubMed  CAS  Google Scholar 

  32. Varma V, Gupta S, Soin AS, Nundy S. Does the presence of jaundice and/or a lump in a patient with gall bladder cancer mean that the lesion is not resectable? Dig Surg. 2009;26:306–311.

    Article  PubMed  Google Scholar 

  33. Kai K, Kohya N, Kitahara K, et al. Tumor budding and dedifferentiation in gallbladder carcinoma: potential for the prognostic factors in T2 lesions. Virchows Archiv. 2011;459:449–456.

    Article  PubMed  CAS  Google Scholar 

  34. Miura F, Asano T, Amano H, et al. New prognostic factor influencing long-term survival of patients with advanced gallbladder carcinoma. Surgery. 2010;148:271–277.

    Article  PubMed  Google Scholar 

  35. Murakami Y, Uemura K, Sudo T, et al. Prognostic factors of patients with advanced gallbladder carcinoma following aggressive surgical resection. J Gastrointest Surg. 2011;15:1007–1016.

    Article  PubMed  Google Scholar 

  36. Kobayashi A, Oda T, Fukunaga K, et al. Invasion of the hepatic artery is a crucial predictor of poor outcomes in gallbladder carcinoma. World J Surg. 2012;36:645–650.

    Article  PubMed  Google Scholar 

  37. Pilgrim C, Usatoff V, Evans PM. A review of the surgical strategies for the management of gallbladder carcinoma based on T stage and growth type of the tumour. Eur J Surg Oncol. 2009;35:903–907.

    Article  PubMed  CAS  Google Scholar 

  38. Steinert R, Nestler G, Sagynaliev E, et al. Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol. 2006;93:682–689.

    Article  PubMed  Google Scholar 

  39. Lee JM, Kim BW, Kim WH, et al. Clinical implication of bile spillage in patients undergoing laparoscopic cholecystectomy for gallbladder cancer. Am Surg. 2011;77:697–701.

    PubMed  Google Scholar 

  40. Maker AV, Butte JM, Oxenberg J, et al. Is port site resection necessary in the surgical management of gallbladder cancer? Ann Surg Oncol. 2012;19:409–417.

    Article  PubMed  Google Scholar 

  41. Han HS, Cho JY, Yoon YS, et al. Preoperative inflammation is a prognostic factor for gallbladder carcinoma. Br J Surg. 2011;98:111–116.

    Article  PubMed  Google Scholar 

  42. He XD, Liu W, Tao LY, et al. Gender-specific prognostic markers of patients with gallbladder cancer after surgical resection. Am Surg. 2010;76:1269–1274.

    PubMed  Google Scholar 

  43. Katz MH, Varadhachary GR, Fleming JB, et al. Serum CA 19–9 as a marker of resectability and survival in patients with potentially resectable pancreatic cancer treated with neoadjuvant chemoradiation. Ann Surg Oncol. 2010;17:1794–1801.

    Article  PubMed  Google Scholar 

  44. Shukla PJ, Neve R, Barreto SG, et al. A new scoring system for gallbladder cancer (aiding treatment algorithm): an analysis of 335 patients. Ann Surg Oncol. 2008;15:3132–3137.

    Google Scholar 

  45. Leon AR. A new scoring system for gallbladder cancer: the first step of a long walk. Ann Surg Oncol. 2008;15:2991–2992.

    Article  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI, 53226, USA

    Charles Henry Caldow Pilgrim, Ryan T. Groeschl, Kiran K. Turaga & T. Clark Gamblin

Authors
  1. Charles Henry Caldow Pilgrim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ryan T. Groeschl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiran K. Turaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. T. Clark Gamblin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charles Henry Caldow Pilgrim.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Pilgrim, C.H.C., Groeschl, R.T., Turaga, K.K. et al. Key Factors Influencing Prognosis in Relation to Gallbladder Cancer. Dig Dis Sci 58, 2455–2462 (2013). https://doi.org/10.1007/s10620-013-2713-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10620-013-2713-y

Keywords

Search

Navigation