Introduction: The survival outcome of resected gallbladder carcinoma remains poor. We conducted a retrospective study to examine factors affecting patient outcomes in resectable gallbladder carcinoma.

Methods: We retrospectively collected data on patients treated at our institution between January 2005 and June 2015 from the electronic medical record using a standardized data collection tool. The univariate Cox proportional hazard model was used for evaluating predictors of overall survival. Kaplan-Meier method was used to compare time-to-events among subgroups and the p values were calculated by the log-rank method. Overall survival (OS) was defined as the time between surgery and death, or censored at the last follow-up date. Progression-free survival (PFS) was defined as the time to recurrence or death.

Results: Of 67 evaluable patients, 65.7% were female. While clinical staging determined 51% to be stage 2 or less, interval portal lymphadenectomy and hepatic resection upstaged 20% to stage 3 or 4. Adjuvant chemotherapy (CT) was given to 18% and adjuvant chemoradiation (CRT) to 15%. About 46% did not receive any post-operative treatment and data was not available in 21%. On multivariate analysis, albumin < 3.5g/dl, LN involvement and pathological (p)Stage >2 were independent predictors of OS and PFS. Median 5 yrs OS and PFS of pstage < 2 was 54% and 54% respectively. Median 5 yr OS and PFS of stage ≥3 was 10.9% and 5.8% respectively. Adjuvant therapy was administered commonly for stage 3 and 4 (20 patients) compared to stage 1 and 2 (2 patients). In stage ≥3, adjuvant therapy improved OS (17.5% vs 8.9% for surgery alone) and PFS (12% vs 0%). Adjuvant chemoradiation for stage 3/4 had better median OS advantage compared to chemotherapy alone (54 m vs 15m, p=0.0008).

Conclusion: The use of adjuvant treatment may improve long-term disease control in patients with node positive tumors. A significant difference between CRT and CT was demonstrated in our series and needs further validation in a larger cohort.

Overall survial (OS) and progression-free survival (PFS) among various subgroups

Group (n) Median OS (months) 5 year OS Median PFS (months) 5 year PFS 
stage 1&2 (21) NA 54% NA 54% 
stage 3&4 (46) 13.4 10.9% 9.4 5.8% 
Surgery + Adjuvant treatment (22) 25.1 15.9% 16.9 10.9% 
Surgery alone (31) 26.1 34.4% 21.3 31.8% 
Surgery + CRT (10) 54.2 35% 45.7 24% 
Surgery + CT (12) 14.9 0% 13.4 0% 
Stage 3 and 4- Surgery + Adjuvant treatment (20) 27.3 17.5% 22.5 12% 
Stage 3 and 4- Surgery alone (15) 2.7 8.9% 2.1 0% 
Group (n) Median OS (months) 5 year OS Median PFS (months) 5 year PFS 
stage 1&2 (21) NA 54% NA 54% 
stage 3&4 (46) 13.4 10.9% 9.4 5.8% 
Surgery + Adjuvant treatment (22) 25.1 15.9% 16.9 10.9% 
Surgery alone (31) 26.1 34.4% 21.3 31.8% 
Surgery + CRT (10) 54.2 35% 45.7 24% 
Surgery + CT (12) 14.9 0% 13.4 0% 
Stage 3 and 4- Surgery + Adjuvant treatment (20) 27.3 17.5% 22.5 12% 
Stage 3 and 4- Surgery alone (15) 2.7 8.9% 2.1 0% 

Citation Format: Lakshminarayanan Nandagopal, Martin J. Heslin, John R. Porterfield, Rojymon Jacob, Peng Li, James Posey, Ravikumar Paluri. Adjuvant therapy associated with improved survival in gall bladder cancer: A single institution retrospective study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3283. doi:10.1158/1538-7445.AM2017-3283