Gallbladder cancer (GBC): 10-year experience at Memorial Sloan-Kettering Cancer Centre (MSKCC)

Abstract

4648 Background: The incidence of GBC in the US is 1.2/ 100,000. Given the dearth of phase III data on the use of adjuvant therapy, institutional review can provide a justification for future studies. This report examines the patterns of presentation, treatment and survival of a large cohort of patients with GBC evaluated at MSKCC over a 10-year period. Methods: A retrospective analysis of patients referred to MSKCC with a diagnosis of GBC between 1/1995 and 12/ 2005 was performed. Patients were identified from the MSKCC cancer registry. Information extracted included, demographics, stage, surgical management, pathology, adjuvant and palliative therapy, date of relapse, death or last follow-up. Date of diagnosis was defined as date of surgery or biopsy. Univariate analysis of survival times and log rank test were employed. Results: 435 GBC cases were identified. 285 (65.5%) females,150 (34.5%) males. Median age 67 years (range 28–100). Pathology: 88% adeno, 4% squamous, 3% neuroendocrine, 2% sarcoma. 36.6% presented as AJCC Stage IV. 47% were discovered incidentally at laparoscopic cholecystectomy (LC). 136 of these were re-explored, of whom 100 (73.5%) had residual disease. Of those who underwent curative resections, 8 received adjuvant chemotherapy, 2 adjuvant radiotherapy and 17 combined chemoradiation. Median OS for the cohort was 9.11 months(m). The median survival(MS) for those presenting with stage IV disease was 4.5 m (95% CI 3.8–6.1) compared to 12.9 m (95% CI 11.7–15.8 m) for those with stage IA-III disease. MS was better for those discovered incidentally at LC (15.7 m,p<.001). For those who underwent re-exploration, MS was 13.9 m if residual disease was present, and 68 m if no residual disease. The MS for those who received adjuvant therapy was 23.4 m. Conclusions: GBC is commonly diagnosed incidentally (47%) at LC. Re- exploration reveals a high incidence of residual disesase (74%). MS is better for patients diagnosed incidentally and those without evidence of disease on re-exploration. Overall prognosis is poor. Although the number of patients was small, adjuvant therapy appeared to confer a survival benefit. Prospective randomized trials of adjuvant therapy are needed in this disease. No significant financial relationships to disclose.