90th Annual Meeting Abstracts
Early Stage Primary Gall Bladder Cancer in The Surveillance Epidemiology and End Results (SEER) Database: The Impact of Extent of Surgical Resection.
*Stephanie R Downing, MD1,2, *Tolulope A. Oyetunji, MD, MPH1, *Kerry-Ann Cadogan1, *Gezzer Ortega1, *Suryanarayana M. Siram, MD1, *David C. Chang, PhD, MPH1,2, LaSalle D. Leffall, MD1, Wayne A.I. Frederick, MD1
1Howard University College of Medicine, Washington, DC;2Johns Hopkins University College of Medicine, Baltimore, MD
Objective: To determine the epidemiology and impact of surgery on survival in early stage primary gall-bladder cancer (GBC).
Design: Retrospective analysis of Surveillance Epidemiology and End Results database.
Patients: Potentially surgically curable GBC patients (stages Tis, T1, T2) who underwent a surgical procedure.
Interventions/Comparison: (1) Simple cholecystectomy versus extended surgical resection (ESR), and (2) number of lymph nodes (LN) resected.
Results: We identified 3209 cases, (58.2% T2, 30.1% T1, 11.7% Tis). Median age at diagnosis was 73 years and 74.8% were female. Median survival was 26 months (Tis, 140 months; T1a, 91 months; T1b, 32 months; T2, 15 months). On multivariate analysis, decreased survival was seen amongst patients aged >60 (HR=1.57, 95%CI=1.30-1.90, p<0.001), increased stage (T1-HR=1.99, 95%CI=1.46-2.70, p<0.001; T2-HR=3.29, 95%CI=2.45-4.43, p<0.001), and LN positivity (regional-HR=1.65, 95%CI=1.39-1.95, p<0.001, distant-HR=2.58, 95%CI=1.54-4.34, p<0.001); while improved survival was found for female patients (HR=0.82, 95%CI=0.70-0.96, p=0.02) and those undergoing ESR (HR=0.59, 95%CI=0.45-0.78, p<0.001). The survival advantage of ESR was seen only in patients with T2 lesions (HR=0.49, 95%CI=0.35-0.68, p<0.001), while there was no survival benefit for ESR in patients with Tis, T1a, or T1b lesions. A subset of 2507 patients had LN excision data, 68.2% having no LN removed, 28.2% 1-4 LN excised and 3.6% 5+ LN excised. On multivariate analysis, patients with 1-4 LN removed had an improved survival over those without LN excision (HR=0.55, 95%CI=0.46-0.66, p<0.001) and those patients with 5+ LN excised had a survival benefit over patients with 1-4 LN removed (HR=0.63, 95%CI=0.40-0.96, p=0.03). Patients with T2 lesions benefited from LN resection (HR=0.42, 95%CI=0.33-0.53, p<0.001).
Conclusion: ESR and/or LN resection may provide a survival benefit in incidentally discovered GBC for certain patients.