title: Prognostic factors in patients with gallbladder cancer after surgical resection: analysis of 279 operated patients.
abstract: BACKGROUND
  Identification of prognostic factors can help predict life expectancy and decide treatment plan. We evaluated prognostic factors in patients with gallbladder cancer (GBC) after surgical resection.
  
  
  METHODS
  Data from 279 patients with GBC who underwent surgery between January 1999 and February 2009 were reviewed retrospectively.
  
  
  RESULTS
  Of the 279 patients, 127 (45.5%) were male; median age was 63 years. R0 resection was achieved in 164 (58.8%) patients, 35 by cholecystectomy and 129 by extended resection. Chemotherapy and radiotherapy were performed in 72 (25.8%) and 55 (19.7%) patients. At a median follow-up of 17.0 months, median overall survival (OS) was 26.0 months. Five-year survival rates for stages I, II, IIIA, IIIB, IVA, and IVB GBC were 94.7%, 75.7%, 44.5%, 21.7%, 4.7%, and 2.6%, respectively. Compared with cholecystectomy, extended resection showed improved OS in all T stages, but statistical significance was observed only in T3 (P<0.001) and T4 (P=0.007). Although OS was similar in patients who received chemotherapy or radiotherapy, radiotherapy significantly improved OS in patients with positive resection margin (P=0.023). Low-grade histologic type (P=0.047) and clear resection margin (P=0.002) were significant predictors of increased OS, but epidemiological factors such as gallstones and anomalous pancreaticobiliary ductal union were not.
  
  
  CONCLUSIONS
  In patients with GBC after surgical resection, TNM stage was the most important prognostic factor. Prognosis was also associated with extent of resection, histologic differentiation, and involvement of resection margin. In patients with positive resection margin, radiotherapy seems to prolong OS.
authors.affiliation: Department of Gastroenterology, Asan Medical Center, University of Ulsan Medical College, Seoul, South Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Lim
authors.forename: Dong Wan
authors.initials: DW
authors.lastname: Seo
authors.forename: Do Hyun
authors.initials: DH
authors.lastname: Park
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.forename: Sung Koo
authors.initials: SK
authors.lastname: Lee
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
authors.forename: Shin
authors.initials: S
authors.lastname: Hwang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D004358:Drug Therapy; D005260:Female; D005706:Gallbladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011182:Postoperative Care; D011379:Prognosis; D011878:Radiotherapy; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome