Skip to main content
SpringerLink
Log in

Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma

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

Abstract

Background

While survival after malignancies is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant by accounting for “accrued” survival time as time progresses. We sought to compare actuarial and CS among patients with gallbladder carcinoma (GBC) .

Methods

A total of 312 patients who underwent curative intent surgery for GBC between 2000 and 2014 were identified using a multi-institutional database. Overall survival (OS) was estimated using the Kaplan–Meier method. CS was calculated as the probability of surviving an additional 3 years at year “x” after surgery using the formula CS3 = S(x+3)/Sx.

Results

Among all patients, the median actuarial OS was 24.8 months (IQR 13.3–88.9). While actuarial survival decreased over time, 3-year CS (CS3) increased, with CS3 at 2 years after surgery noted to be 61.8 % compared with the 5-year actuarial OS of 31.6 %. Factors associated with reduced actuarial OS were positive margin status (HR 3.61, 95 % CI 2.47–5.26), increasing tumor size (HR = 1.02, 95 % CI 1.01–1.02), higher tumor grade (HR 2.98, 95 % CI 1.47–6.04), residual disease at repeat resection (HR = 2.78, 95 % CI 1.49–3.49, p < 0.001), and lymph node metastasis (HR = 1.95, 95 % CI 1.39–2.75, all p < 0.001). The calculated CS3 exceeded the actuarial survival within each high-risk patient subgroup. For example, patients with residual disease at repeat resection had an actuarial survival 23.1 % at 5 years versus a CS3 of 56.3 % in patients alive at 2 years (Δ = 33.2 %).

Conclusions

CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients. CS estimates can be used to accurately predict survival and guide clinical decision making.

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
Fig. 2

Similar content being viewed by others

References

  1. Lazcano-Ponce EC, Miquel JF, Muñoz N, Herrero R, Ferrecio C, Wistuba II, et al. Epidemiology and molecular pathology of gallbladder cancer. CA Cancer J Clin. 2001;51:349–64.

    Article  CAS  PubMed  Google Scholar 

  2. Kayahara M, Nagakawa T. Recent trends of gallbladder cancer in Japan: an analysis of 4,770 patients. Cancer. 2007;110:572–80.

    Article  PubMed  Google Scholar 

  3. Donohue JH, Stewart AK, Menck HR. The National Cancer Data Base report on carcinoma of the gallbladder, 1989–1995. Cancer. 1998;83:2618–28.

    Article  CAS  PubMed  Google Scholar 

  4. Müller BG, De Aretxabala X, González Domingo M. A review of recent data in the treatment of gallbladder cancer: what we know, what we do, and what should be done. Am Soc Clin Oncol Educ Book 2014:e165–70.

  5. De Aretxabala X, Roa I, Burgos L, Losada H, Roa JC, Mora J, et al. Gallbladder cancer: an analysis of a series of 139 patients with invasion restricted to the subserosal layer. J Gastrointest Surg. 2006;10:186–92.

    Article  PubMed  Google Scholar 

  6. Foster JM, Hoshi H, Gibbs JF, Iyer R, Javle M, Chu Q, et al. Gallbladder cancer: defining the indications for primary radical resection and radical re-resection. Ann Surg Oncol. 2007;14:833–40.

    Article  PubMed  Google Scholar 

  7. Duffy A, Capanu M, Abou-Alfa GK, Huitzil D, Jarnagin W, Fong Y, et al. Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Center (MSKCC). J Surg Oncol. 2008;98:485–9.

    Article  CAS  PubMed  Google Scholar 

  8. Wakabayashi H, Ishimura K, Hashimoto N, Otani T, Kondo A, Maeta H. Analysis of prognostic factors after surgery for stage III and IV gallbladder cancer. Eur J Surg Oncol. 2004;30:842–6.

    Article  CAS  PubMed  Google Scholar 

  9. Lepage C, Capocaccia R, Hackl M, Lemmens V, Molina E, Pierannunzio D, et al. Survival in patients with primary liver cancer, gallbladder and extrahepatic biliary tract cancer and pancreatic cancer in Europe, 1999–2007: results of EUROCARE-5. Eur J Cancer. In press.

  10. Ishihara S, Miyakawa S, Takada T, Takasaki K, Nimura Y, Tanaka M, et al. Status of surgical treatment of biliary tract cancer. Dig Surg. 2007;24:131–6.

    Article  PubMed  Google Scholar 

  11. Shimizu H, Kimura F, Yoshidome H, Ohtsuka M, Kato A, Yoshitomi H, et al. Aggressive surgical approach for stage IV gallbladder carcinoma based on Japanese Society of Biliary Surgery classification. J Hepatobiliary Pancreat Surg. 2007;14:358–65.

    Article  PubMed  Google Scholar 

  12. Kai M, Chijiiwa K, Ohuchida J, Nagano M, Hiyoshi M, Kondo K. A curative resection improves the postoperative survival rate even in patients with advanced gallbladder carcinoma. J Gastrointest Surg. 2007;11:1025–32.

    Article  PubMed  Google Scholar 

  13. Choi SB, Han HJ, Kim CY, Kim WB, Song T-J, Suh SO, et al. Surgical outcomes and prognostic factors for T2 gallbladder cancer following surgical resection. J Gastrointest Surg. 2010;14:668–78.

    Article  PubMed  Google Scholar 

  14. Chijiiwa K, Nakano K, Ueda J, Noshiro H, Nagai E, Yamaguchi K, et al. Surgical treatment of patients with T2 gallbladder carcinoma invading the subserosal layer. J Am Coll Surg. 2001;192:600–7.

    Article  CAS  PubMed  Google Scholar 

  15. Ishihara S, Horiguchi A, Miyakawa S, Endo I, Miyazaki M, Takada T. Biliary tract cancer registry in Japan from 2008 to 2013. J Hepatobiliary Pancreat Sci. In press.

  16. Nevin JE, Moran TJ, Kay S, King R. Carcinoma of the gallbladder: staging, treatment, and prognosis. Cancer. 1976;37:141–8.

    Article  CAS  PubMed  Google Scholar 

  17. Oh TG, Chung MJ, Bang S, Park SW, Chung JB, Song SY, et al. Comparison of the sixth and seventh editions of the AJCC TNM classification for gallbladder cancer. J Gastrointest Surg. 2013;17:925–30.

    Article  PubMed  Google Scholar 

  18. Zabor EC, Gonen M, Chapman PB, Panageas KS. Dynamic prognostication using conditional survival estimates. Cancer. 2013;119:3589–92.

    Article  PubMed  Google Scholar 

  19. Spolverato G, Kim Y, Ejaz A, Alexandrescu S, Marques H, Aldrighetti L, et al. Conditional probability of long-term survival after liver resection for intrahepatic cholangiocarcinoma. JAMA Surg. In press.

  20. Cucchetti A, Piscaglia F, Cescon M, Ercolani G, Terzi E, Bolondi L, et al. Conditional survival after hepatic resection for hepatocellular carcinoma in cirrhotic patients. Clin Cancer Res. 2012;18:4397–405.

    Article  PubMed  Google Scholar 

  21. Kim Y, Margonis GA, Prescott JD, Tran TB, Postlewait LM, Maithel SK, et al. Curative surgical resection of adrenocortical carcinoma: determining long-term outcome based on conditional disease-free probability. Ann Surg. In press.

  22. Nathan H, de Jong MC, Pulitano C, Ribero D, Strub J, Mentha G, et al. Conditional survival after surgical resection of colorectal liver metastasis: an international multi-institutional analysis of 949 patients. J Am Coll Surg. 2010;210:755–64, 764–6.

    Google Scholar 

  23. Mayo SC, Nathan H, Cameron JL, Olino K, Edil BH, Herman JM, et al. Conditional survival in patients with pancreatic ductal adenocarcinoma resected with curative intent. Cancer. 2012;118:2674–81.

    Article  PubMed  Google Scholar 

  24. Kim Y, Ejaz A, Spolverato G, Squires MH, Poultsides G, Fields RC, et al. Conditional survival after surgical resection of gastric cancer: a multi-institutional analysis of the us gastric cancer collaborative. Ann Surg Oncol. 2015;22:557–64.

    Article  PubMed  Google Scholar 

  25. Bischof DA, Kim Y, Dodson R, Jimenez MC, Behman R, Cocieru A, et al. Conditional disease-free survival after surgical resection of gastrointestinal stromal tumors: a multi-institutional analysis of 502 patients. JAMA Surg. 2015;150:299–306.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Skuladottir H, Olsen JH. Conditional survival of patients with the four major histologic subgroups of lung cancer in Denmark. J Clin Oncol. 2003;21:3035–40.

    Article  PubMed  Google Scholar 

  27. Crespi CM, Smith SK, Petersen L, Zimmerman S, Ganz PA. Measuring the impact of cancer: a comparison of non-Hodgkin lymphoma and breast cancer survivors. J Cancer Surviv. 2010;4:45–58.

    Article  PubMed  Google Scholar 

  28. Burnand B, Kernan WN, Feinstein AR. Indexes and boundaries for “quantitative significance” in statistical decisions. J Clin Epidemiol. 1990;43:1273–84.

    Article  CAS  PubMed  Google Scholar 

  29. De Aretxabala X, Roa I, Hepp J, Maluenda F, Mordojovich G, Leon J, et al. Early gallbladder cancer: is further treatment necessary? J Surg Oncol. 2009;100:589–93.

    Article  PubMed  Google Scholar 

Download references

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Stefan Buettner BSc, Georgios Antonios Margonis MD, PhD, Yuhree Kim MD, MPH, Faiz Gani MBBS & Timothy M. Pawlik MD, MPH PhD

  2. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Cecilia G. Ethun MD & Shishir K. Maithel MD

  3. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George A. Poultsides MD & Thuy Tran MD

  4. Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Kamran Idrees MD & Chelsea A. Isom MD

  5. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ryan C. Fields MD & Bradley Krasnick MD

  6. Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

    Sharon M. Weber MD & Ahmed Salem MD

  7. Department of Surgery, University of Louisville, Louisville, KY, USA

    Robert C. G. Martin MD, PhD & Charles R. Scoggins MD, MBA

  8. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Perry Shen MD & Harveshp D. Mogal MD

  9. Department of Surgery, Ohio State University, Columbus, OH, USA

    Carl Schmidt MD & Eliza Beal MD

  10. Department of Surgery, New York University, New York, NY, USA

    Ioannis Hatzaras MD & Rivfka Shenoy MD

Authors
  1. Stefan Buettner BSc
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Georgios Antonios Margonis MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yuhree Kim MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Faiz Gani MBBS
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Cecilia G. Ethun MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. George A. Poultsides MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thuy Tran MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Kamran Idrees MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Chelsea A. Isom MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ryan C. Fields MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Bradley Krasnick MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Sharon M. Weber MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ahmed Salem MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Robert C. G. Martin MD, PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Charles R. Scoggins MD, MBA
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Perry Shen MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Harveshp D. Mogal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Carl Schmidt MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Eliza Beal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Ioannis Hatzaras MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Rivfka Shenoy MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Shishir K. Maithel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Timothy M. Pawlik MD, MPH PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Buettner, S., Margonis, G.A., Kim, Y. et al. Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma. Ann Surg Oncol 23, 4401–4409 (2016). https://doi.org/10.1245/s10434-016-5470-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-016-5470-2

Keywords

Search

Navigation