Abstract
Background
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.
Results
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).
Conclusions
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.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Kasumova GG, Tabatabaie O, Najarian RM, Callery MP, Ng SC, Bullock AJ, et al. Surgical management of gall bladder cancer: simple versus extended cholecystectomy and the role of adjuvant therapy. Ann Surg 2017; 266:625–631.
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.
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.
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.
Verslype C, Prenen H, Cutsem EV, The role of chemotherapy in biliary tract carcinoma. HPB 2008;10:164–167.
Chijiiwa K, Nakano K, Ueda J, Noshiro H, Nagai E, Yamaguchi K, et al. Surgical treatment of patients with T2 gall bladder carcinoma invading the subserosal layer. J Am Coll Surg. 2001;192:600–607.
Aloia TA, Jarufe N, Javle M, Maithel SK, Roa JC, Adsay V, et al. Gall bladder Cancer: expert consensus statement. HPB 2015;17:681–690.
Go SI, Kim YS, Hwang IG, Kim EY, Oh SY, Ji JH, et al. Is there a role for adjuvant therapy in R0 resected gall bladder cancer?: a propensity score-,matched analysis. Can Res Treat 2016;48(4):1274–85.
Wang SJ, Lemieux A, Kalpathy-Cramer J, Ord CB, Walker GV, Fuller CD, et al. Normogram for predicting the benefit of adjuvant chemoradiotherapy for resected gall bladder cancer. J Clin Oncol. 2011;29:4627–32.
Park HS, Lim JY, Yoon DS, Park S, Lee DK Lee SJ, et al. Outcome of adjuvant therapy in gall bladder cancer. Oncology 2010; 79:168–173.
McNamara MG, Walter T, Horgan AM, Amir E, Cleary S, McKeever EL, et al. Outcome of adjuvant therapy in biliary tract cancers. Am J Clin Oncol.2015;38:382–387.
Siebenhuner AR, Seifert H, Bachmann H, Seifert B, Winder T, Feilchenfeldt J, et al. Adjuvant treatment in resectable biliary tract cancer with cisplatin plus gemcitabine: A prospective single centre phase II study. BMC Cancer 2018;18:72.
Lee HY, Kim YH, Jung GJ, Roh YH, Park SY, Kang NU, et al. Prognostic factors for gall bladder cancer in the laparoscopic era. J Korean Surg. Soc. 2012;83(4):227–236.
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.
Dutta U. Gall bladder cancer: can newer insights improve outcome?, Journal of Gastroeneterology and Hepatology 2012; 27:642–653.
Horgan Am, Amir E, Walter T, Knox JJ. Adjuvant therapy in the treatment of biliary tract cancer: a systematic review and meta-analysis. J Clin Oncol 2012;30(16):1934–40.
Ma N, Cheng H, Qin B, Zhong R, Wang B. Adjuvant therapy in the treatment of gall bladder cancer: a meta-analysis. BMC Cancer 2015;15:615-
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).
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.
Author information
Authors and Affiliations
Contributions
AKK and SP have contributed equally towards concept, design, data collection and analysis, interpretation and final approval of the manuscript.
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kattepur, A.K., Patkar, S., Goel, M. et al. Role of Adjuvant Chemotherapy in Resected T2N0 Gall Bladder Cancer. J Gastrointest Surg 23, 2232–2238 (2019). https://doi.org/10.1007/s11605-019-04104-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-019-04104-4