title: Predictors of long-term survival in patients with gallbladder cancer.
abstract: The aim of this study was to examine the predictors of long-term survival (> 24 months) in patients with gall bladder cancer. A retrospective review of 117 cases of gall bladder cancer resected between 1989 and 2000. The resections included 80 simple cholecystectomies and 37 extended procedures. Patients with survival > 24 months (n = 44) were compared with those having survival < 24 months (n = 73) for 17 prognostic factors. Overall median survival was 16 months with a 5-year survival of 27%. T status (P = .000) and adjuvant chemoradiotherapy (P = .001) were independent predictors of long-term survival. Survival advantage was seen in T3N+ve disease (P = .007) with extended procedures. Complete (R0) resection was attained in 30 patients with a 5-year survival advantage of 30% as compared with incomplete (R1) resection (P = .0002). Adjuvant chemoradiotherapy improved survival in simple cholecystectomy group (P = .0008) but no advantage was seen after extended procedures. Stage III (P = .001) and node-positive disease (P = .0005) had significant benefit with adjuvant therapy. Poor differentiation and vascular invasion were associated with poor long-term survival. R0 resection was associated with prolonged survival. Extended procedures improved survival in patients with T3N+ve disease. Addition of chemoradiotherapy made significant improvement in long-term survival in stage III and node-positive lesions and in patients undergoing simple cholecystectomy. R0 resection predicted long-term survival in gall bladder cancer. T3 N+ve disease had better survival after extended procedures. Adjuvant chemoradiotherapy improved survival in stage III and node-positive disease. Poor differentiation and vascular invasion were adverse predictors of survival.
authors.affiliation: Department of Surgical Gastroenterology, Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India.
authors.forename: Palat
authors.initials: P
authors.lastname: Balachandran
authors.forename: Shaleen
authors.initials: S
authors.lastname: Agarwal
authors.forename: Narendra
authors.initials: N
authors.lastname: Krishnani
authors.forename: Chandra M
authors.initials: CM
authors.lastname: Pandey
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.forename: Sadiq S
authors.initials: SS
authors.lastname: Sikora
authors.forename: Rajan
authors.initials: R
authors.lastname: Saxena
authors.forename: Vinay K
authors.initials: VK
authors.lastname: Kapoor
mesh_terms: D000328:Adult; D000368:Aged; D002454:Cell Differentiation; D017024:Chemotherapy, Adjuvant; D002763:Cholecystectomy / Q000401:mortality; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D016019:Survival Analysis