Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study
Where a muscle-invading gallbladder tumour sits matters: those on the side against the liver spread more and killed more, with five-year survival of 43 in 100 against 65 in 100 for tumours on the free side.
Overview
Four institutions analysed 437 resected gallbladder cancers, defining tumour location as hepatic side or peritoneal side. Among 252 T2 tumours, hepatic-side tumours (99) had more vascular invasion (51 versus 19 percent), neural invasion (33 versus 8 percent) and nodal metastasis (40 versus 17 percent) than peritoneal-side tumours (153). After a median follow-up of 58.9 months, three- and five-year survival was 52.1 and 42.6 percent for hepatic-side and 73.7 and 64.7 percent for peritoneal-side T2 tumours (p=0.0006); no such difference was seen for T1 or T3. Hepatic-side location was independently associated with survival (hazard ratio 2.7, 95 percent CI 1.7 to 4.2) and predicted liver recurrence (23 versus 3 percent) and distant nodal recurrence (16 versus 3 percent) even after radical resection.
- Five-year survival 42.6 percent for hepatic-side vs 64.7 percent for peritoneal-side T2 tumours (p=0.0006).
- Hepatic-side location: hazard ratio 2.7 (95 percent CI 1.7 to 4.2) for death; nodal metastasis 40 vs 17 percent.
- Liver recurrence 23 vs 3 percent and distant nodal recurrence 16 vs 3 percent after radical resection.
The study behind the T2a/T2b split adopted by the AJCC eighth edition in 2017, the one staging change in gallbladder cancer that grew from the disease's own anatomy rather than from bile duct cancer.
- Retrospective, four referral centres.
- Location was assigned on pathology review; reproducibility between pathologists is a known difficulty.
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