Role of Adjuvant Chemotherapy in Resected T2N0 Gall Bladder Cancer
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Management of operable gall bladder cancer (GBC) is closely related to its tumor (T) and nodal (N) status. The magnitude of benefit with adjuvant chemotherapy in completely resected, node negative T2 cancers is not completely defined.
Materials and Methods
Retrospective analysis of patients diagnosed with pathological T2N0 (stage II, 7th edition AJCC) GBCs from January 2011 to June 2016 was evaluated for adverse risk factors, adjuvant treatment received, recurrence-free survival (RFS), and overall survival (OS). Survival analysis was done using Kaplan-Meier and Cox regression tools.
Of the 88 patients included, 30 received adjuvant chemotherapy while 58 were observed. The OS and RFS in the entire cohort were 82.9% and 62.7%, respectively, at a median follow-up of 44.18 months. The OS and RFS in the chemotherapy group were 85.1% and 76.4% while it was 81.4% and 55.5% in the observation group (p = 0.50). Recurrent disease was seen in 30.7%.The presence of lymphovascular invasion predicted inferior RFS (p = 0.031).
Adjuvant chemotherapy may reduce distant failure rates but did not improve OS in completely resected T2N0 GBC patients in this study. LVI predicted inferior RFS in T2N0 patients. An evaluation of adverse prognostic factors would help design personalized treatment strategies for this select cohort of T2N0 GBC.
KeywordsGall bladder cancer Adjuvant chemotherapy T2N0 Lymphovascular invasion (LVI)
AKK and SP have contributed equally towards concept, design, data collection and analysis, interpretation and final approval of the manuscript.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 2.Stein A, Arnold D, Bridgewater J, Goldstein D, Jensen LH, Klumpen HJ, et al. Adjuvant chemotherapy with gemcitabine and cisplatin compared to observation after curative intent resection of cholangiocarcinoma and muscle invasive gall bladder carcinoma (ACTICCA-1 trial): A randomised, multidisciplinary, multinational phase III trial. BMC Cancer 2015;15:564.CrossRefGoogle Scholar
- 3.Choudhary S, Asthana AK. Impact of adjuvant therapy on survival in curatively resected gall bladder carcinoma. Journal of Clinical and Diagnostic Research 2015; 9(9):XCO1-XCO4.Google Scholar
- 4.Glazer ES, Liu P, Abdalla EK, Vauthey JN, Curley SA. Neither neoadjuvant nor adjuvant therapy increases survival after biliary tract cancer resection with wide negative margins. J Gastrointest Surg 2012;16(9):1666–1671.Google Scholar
- 14.Ostwal V, Harris C, Sirohi B, Goel M, Bal M, Kannan S, et al. Role of adjuvant chemotherapy in T2N0M0 periampullary cancers. Asia Pac J Clin Oncol 2017;13(5):e298–e303.Google Scholar
- 18.Edeline J, Bonnetain F, Phelip J, et al. GemOx versus surveillance following surgery of localised biliary tract cancer: Results of the PRODIGE 12-ACCORD 18(UNICANCER GI) phase III trial. J ClinOncol 2017; 35(suppl 4S; abstr 225).Google Scholar
- 19.Primrose JN, Fox R, Palmer DH, Prasad R, Mirza D, Anthoney DA. BILCAP. A randomised clinical trial evaluating adjuvant chemotherapy with capecitabine compared to expectant treatment alone following curative surgery for biliary tract cancer. J ClinOncol. 2011;29(supl;abstr 4125):4125.Google Scholar