Tumor location and concurrent liver resection, impact survival in T2 gallbladder cancer: a meta-analysis of the literature
A second pooled analysis of muscle-invading gallbladder cancer found tumours on the liver side about three times as deadly, found removing part of the liver helped only that group, and found chemotherapy after surgery did not change the risk of death.
Overview
Meta-analysis of nine retrospective studies (2014 to 2020, 2,345 patients) reporting hazard ratios for survival in T2 gallbladder cancer. Hepatic-side (T2b) tumours had higher mortality (hazard ratio 3.16, 95 percent CI 2.11 to 4.74; I2 0 percent). Liver resection was associated with better five-year overall survival only in T2b (odds ratio 2.20, 1.33 to 3.63; I2 67 percent). Adjuvant chemotherapy was not associated with lower mortality (hazard ratio 0.98, 0.83 to 1.16). The authors propose that T2a tumours can be managed without hepatic resection and offer a mortality risk score.
- T2b mortality hazard ratio 3.16 (95 percent CI 2.11 to 4.74).
- Liver resection improved five-year survival only in T2b: odds ratio 2.20 (1.33 to 3.63).
- Adjuvant chemotherapy: hazard ratio 0.98 (0.83 to 1.16), no association with mortality.
Consistent with Kang and colleagues on prognosis, and more optimistic about liver resection for T2b. The adjuvant chemotherapy finding is retrospective and predates gallbladder-specific analysis of BILCAP, but it is a warning that the adjuvant benefit in this disease is not established.
- Retrospective data with selection into liver resection.
- Heterogeneity was high for the liver resection comparison (I2 67 percent).
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