TITLE:
Improved Outcomes in Gallbladder Cancer with Early Diagnosis and Negative Nodal Status
AUTHORS:
Lauren Smithson, Christopher Keto, Lorenzo Ferguson, Sumet Silapaswan, Michael J. Jacobs, Ramachandra Kolachalam, Jeffrey C. Flynn, Vijay K. Mittal
KEYWORDS:
Gallbladder; Carcinoma; Node Status; Survival
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.3 No.2,
April
24,
2012
ABSTRACT: Background: Gallbladder cancer (GBC) is a rare disease of the hepatobiliary tract characterized by silent presentation, poor prognosis, and limited therapy. Current imaging modalities, clinical symptoms and laboratory values are of limited value in diagnosis and tumour markers are used as a clinical adjunct. Five year survival is 5% - 12% and a majority of patients survive less than 1 year. Early identification, negative nodal status, and extended cholecystectomy improve survival; adjuvant therapy does not appear to play a role. Objective: To evaluate the effects of stage and nodal status of GBC on survival by analyzing clinical and radiological factors leading to preoperative diagnosis and appropriate subsequent management. Results: Forty-three patients (31 female, 12 male) had primary GBC. Average age was 69 years. The most common presenting symptom was pain (65%). Fifteen (35%) patients presented with acute cholecystitis; 9 were suspicious for a mass. Ultrasound and computed tomography were the imaging modalities most often used. Preoperative diagnoses were made in only 7 (16%) patients, whereas 16 (37%) patients were diagnosed intra-operatively and 20 (47%) post-operatively. Adjuvant chemotherapy was offered in 16 (37%) patients. Average survival was 28 months (range 0.5 - 238 months), with a 5-year survival of 13% across all stages. Early GBC (stages 1 - 2) had a 5-year survival of 43%, and late GBC (stages 3 - 4) had no survival at 5 years, with an average survival of 9 months. Positive nodes decreased survival. Conclusion: Our results mirror what has been reported in the literature. Most patients presented with acute cholecystitis, with confounding clinical data, but few were preoperatively diagnosed with GBC. Imaging was rarely diagnostic. Late stage GBC, as well as node-positive status, had dismal outcomes with low 1-year and 5-year survival rates. Improved preoperative suspicion of early GBC would allow for more intentional curative resections, before nodes become positive.