Abstract 3283: Adjuvant therapy associated with improved survival in gall bladder cancer: A single institution retrospective study
Authors: Nandagopal Lakshminarayanan , Heslin Martin J. , Porterfield John R. , Jacob Rojymon , Li Peng , Posey James , Paluri Ravikumar 
Published: July 2017

Introduction: The survival outcome of resected gallbladder carcinoma remains poor. We conducted a retrospective study to examine factors affecting patient outcomes in resectable gallbladder carcinoma.

Methods: We retrospectively collected data on patients treated at our institution between January 2005 and June 2015 from the electronic medical record using a standardized data collection tool. The univariate Cox proportional hazard model was used for evaluating predictors of overall survival. Kaplan-Meier method was used to compare time-to-events among subgroups and the p values were calculated by the log-rank method. Overall survival (OS) was defined as the time between surgery and death, or censored at the last follow-up date. Progression-free survival (PFS) was defined as the time to recurrence or death.

Results: Of 67 evaluable patients, 65.7% were female. While clinical staging determined 51% to be stage 2 or less, interval portal lymphadenectomy and hepatic resection upstaged 20% to stage 3 or 4. Adjuvant chemotherapy (CT) was given to 18% and adjuvant chemoradiation (CRT) to 15%. About 46% did not receive any post-operative treatment and data was not available in 21%. On multivariate analysis, albumin &lt; 3.5g/dl, LN involvement and pathological (p)Stage &gt;2 were independent predictors of OS and PFS. Median 5 yrs OS and PFS of pstage &lt; 2 was 54% and 54% respectively. Median 5 yr OS and PFS of stage ≥3 was 10.9% and 5.8% respectively. Adjuvant therapy was administered commonly for stage 3 and 4 (20 patients) compared to stage 1 and 2 (2 patients). In stage ≥3, adjuvant therapy improved OS (17.5% vs 8.9% for surgery alone) and PFS (12% vs 0%). Adjuvant chemoradiation for stage 3/4 had better median OS advantage compared to chemotherapy alone (54 m vs 15m, p=0.0008).

Conclusion: The use of adjuvant treatment may improve long-term disease control in patients with node positive tumors. A significant difference between CRT and CT was demonstrated in our series and needs further validation in a larger cohort.

Overall survial (OS) and progression-free survival (PFS) among various subgroupsGroup (n)Median OS (months)5 year OSMedian PFS (months)5 year PFSstage 1&2 (21)NA54%NA54%stage 3&4 (46)13.410.9%9.45.8%Surgery + Adjuvant treatment (22)25.115.9%16.910.9%Surgery alone (31)26.134.4%21.331.8%Surgery + CRT (10)54.235%45.724%Surgery + CT (12)14.90%13.40%Stage 3 and 4- Surgery + Adjuvant treatment (20)27.317.5%22.512%Stage 3 and 4- Surgery alone (15)2.78.9%2.10%

Citation Format: Lakshminarayanan Nandagopal, Martin J. Heslin, John R. Porterfield, Rojymon Jacob, Peng Li, James Posey, Ravikumar Paluri. Adjuvant therapy associated with improved survival in gall bladder cancer: A single institution retrospective study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 3283. doi:10.1158/1538-7445.AM2017-3283