title: Clinicopathological features and management of gallbladder cancer in Pakistan: a prospective study of 233 cases.
abstract: OBJECTIVE
  Gallbladder cancer is common in Pakistan and has an extremely poor prognosis. Treatment is primarily surgical. Chemotherapy is frequently used in patients with advanced disease. This study was performed to evaluate and compare the clinicopathological features and management of gallbladder cancer in Pakistani patients, with particular emphasis on factors that influence survival.
  
  
  METHODS
  Two hundred and thirty-three patients with histologically proven gallbladder cancer were studied. Information was prospectively collected on demographic features, clinical and laboratory findings at the time of presentation, influence of therapy, and survival. Data were analyzed to evaluate variables that influenced survival. Kaplan-Meier analysis was used to calculate survival.
  
  
  RESULTS
  Most patients were women (77%). Mean age was 55 years (+/-11 years). Fourteen per cent of females were nulliparous. Twenty-six per cent had five or more children. Only 4% of patients had a documented history of typhoid fever. The majority (69%) had a history of symptomatic gallbladder disease. The commonest presenting symptom was pain (89%), followed by nausea and vomiting (52%), weight loss (42%), and jaundice (33%). One-quarter of patients had a palpable abdominal mass. Most had abnormal hepatic function tests and 58% had elevated carcinoma embryonic antigen levels. Stage (P < 0.001), jaundice (P = 0.01) and palpable mass (P = 0.02) were statistically significant variables. However, on multivariate analysis, tumor node metastases (TNM) stage was the only factor influencing survival. Median survival of the patients was 44 months for patients with stage I disease, 23 months for stage II, 17 months for stage III and 6 months for stage IV.
  
  
  CONCLUSIONS
  These data are comparable with those reported from other developing countries. Most patients presented at an advanced stage of disease and had an extremely poor prognosis. Systemic therapy did not provide any survival benefit. The TNM stage remains the most important factor influencing survival.
authors.affiliation: National Cancer Institute, Karachi, Pakistan. imalik@ahs.llumc.edu
authors.forename: Imtiaz A
authors.initials: IA
authors.lastname: Malik
mesh_terms: D000230:Adenocarcinoma / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D005706:Gallbladder Neoplasms / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010154:Pakistan / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate