Surgical outcomes in gallbladder cancer: evidence from the UK nationwide CAPBIL study
Among 516 people operated on for gallbladder cancer at 24 UK centres, how far the tumour had grown and whether nodes were involved decided survival, and chemotherapy after surgery showed no measurable benefit once like was compared with like.
Overview
UK HPB Research Collaborative Group analysis of 516 patients who underwent surgery for gallbladder cancer at 24 UK centres between January 2014 and December 2022, with a median follow-up of 25 months. T3 to T4 tumours more often presented with jaundice, were non-incidental and underwent major hepatectomy, which carried higher major morbidity and 30-day mortality. In propensity score-matched analysis, adjuvant therapy showed no significant benefit in disease-free or overall survival. On multivariable analysis T3 to T4 stage, nodal disease and perineural invasion predicted poorer disease-free survival, and T3 to T4 stage and nodal disease poorer overall survival.
- 516 patients operated at 24 UK centres, 2014 to 2022; median follow-up 25 months.
- Propensity-matched analysis: no significant disease-free or overall survival benefit from adjuvant therapy.
- T3 to T4 stage, nodal disease and perineural invasion predicted poorer disease-free survival.
The adjuvant finding sits uneasily beside BILCAP, on which NHS adjuvant capecitabine rests; in a mostly gallbladder population the benefit is not visible. ACTICCA-1 and ARTEMIDE-Biliary01 are the trials that can settle it.
- Observational; adjuvant therapy was given selectively and matching cannot remove all confounding.
- Median follow-up of 25 months is short for survival endpoints.
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