K. Mahendraraj1, C. S. Lau1,3, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Surgery,Livingston, NJ, USA 2New Jersey Medical School,Surgery,Newark, NJ, USA 3Saint George’s University,Grenada, Grenada, Grenada
Introduction: Gallbladder carcinoma (GBC) is the most common malignancy of the biliary tract and third most common gastrointestinal tract malignancy. Although GBC is much less prevalent in North America compared to Asia, it is associated with extremely poor prognosis. This study examines a large cohort of GBC patients in the United States in an effort to define demographics, clinical and pathologic features impacting clinical outcomes in GBC patients.
Methods: Demographic and clinical data on 14,903 GBC patients was abstracted from the SEER database (1973–2012). Statistical analysis was performed with SPSS©v20.0 software using Chi-square test, paired t-test, multivariate analysis, and Kaplan-Meier functions.
Results: 14,903 cases of GBC were abstracted with a mean age of 71 years. GBC was significant more common among Caucasian (65.3%) females (71.9%), p<0.001. GBC was most often poorly or moderately differentiated (40.9% and 40.1%), p<0.001). 37.6% of GBC cases presented with distant metastasis, p<0.01. Surgery was the most common treatment modality for GBC patients (60.7%), p<0.001. Combination surgery and radiation, which was utilized in 11.5% of GBC patients, achieved similar survival rates compared to surgery alone (3.637 vs. 3.435 years, p<0.001). There was a significant increase in GBC incidence since 2000, with a rise in mean incidence of 1.8% between 1973 and 1999 period to 4.6% between 2000 and 2010, accompanying a rise in the mean incidence of surgical resection from 2.5% from1973 to 1999 to 5.0% from 2000 to 2010. Overall mortality was 86.8%, with 1- and 5-year survival rates of 35% and 13%, respectively, p<0.001. Multivariate analysis identified regional (OR 2.8) or distant disease (OR 2.1), lymph node positivity (OR 1.6), undifferentiated grade (OR 1.3), Caucasian race (OR 2.0), and male gender (OR 1.2) as independently associated with increased mortality for GBC, p<0.001.
Conclusions: GBC is an uncommon malignancy that presents most often among Caucasians females in their 8th decade of life, with over a third of cases presenting with distant metastasis. The incidence of GBC has doubled in the last decade concurrent with increases in cholecystectomy rates attributable in part to improved histopathological detection, as well as laparoscopic advances and enhanced endoscopic techniques. Surgical resection confers significant survival benefit in GBC patients, although a significant portion of GBC patients with regional disease remain untreated or undertreated. Given its rarity, all GBC patients should be enrolled in clinical trials or registries to optimize treatment and clinical outcomes for these patients.
