title: Gallbladder cancer: differences in presentation, surgical treatment, and survival in patients treated at centers in three countries.
abstract: BACKGROUND
  Gallbladder cancer (GBCA) is a rare malignancy with a variable incidence worldwide. This study analyzed GBCA patients treated at centers in 3 countries. The aim was to assess for location-specific differences in presentation and outcomes, which might suggest differences in pathogenesis or disease biology.
  
  
  METHODS
  Data for consecutive patients submitted to operation at Instituto Oncológico Fundación Arturo López Pérez (FALP, Chile), Yokohama City University (YCU, Japan), and Memorial Sloan-Kettering Cancer Center (MSKCC, USA) between 1999 and 2007 were studied retrospectively. Patient demographics, disease- and treatment-related variables and outcomes were analyzed by chi-square, Kruskal-Wallis, and log-rank test.
  
  
  RESULTS
  Two hundred sixty-one patients (MSKCC, 130; FALP, 85; YCU, 46) underwent exploration, and 160 (MSKCC, 91; FALP, 33; YCU, 36) underwent R0 resection. Patients treated at FALP were younger (median 57 years, p < 0.001) and more often female (80%, p < 0.005); at YCU there were fewer patients with incidental tumors (19.5% compared with more than 60% at FALP and MSKCC, p < 0.001). En bloc liver and bile duct resections were performed more commonly at MSKCC and YCU (p < 0.001). Patients treated at FALP had more advanced tumor stage compared with those treated at MSKCC and YCU (p < 0.001). Disease-specific survival (DSS) was not different among the groups when patients submitted to an R0 resection were analyzed (p = 0.12). On multivariate analysis, T-stage, nodal involvement, and bile duct involvement were predictors of DSS; center was not significant.
  
  
  CONCLUSIONS
  Despite some differences in presentation, disease extent, and surgical treatment, DSS after curative intent resection was similar among all 3 groups. The most important predictors of outcomes were related to tumor extent rather than country of origin.
authors.affiliation: Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
authors.forename: Jean M
authors.initials: JM
authors.lastname: Butte
authors.forename: Kenichi
authors.initials: K
authors.lastname: Matsuo
authors.forename: Mithat
authors.initials: M
authors.lastname: Gönen
authors.forename: Michael I
authors.initials: MI
authors.lastname: D'Angelica
authors.forename: Enrique
authors.initials: E
authors.lastname: Waugh
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Allen
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
authors.forename: Ronald P
authors.initials: RP
authors.lastname: DeMatteo
authors.forename: Leslie
authors.initials: L
authors.lastname: Blumgart
authors.forename: Itaru
authors.initials: I
authors.lastname: Endo
authors.forename: Hernán
authors.initials: H
authors.lastname: De La Fuente
authors.forename: William R
authors.initials: WR
authors.lastname: Jarnagin
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006498:Hepatectomy; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016577:Pancreaticoduodenectomy; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome