title: Carcinoma of the gallbladder: patterns of presentation, prognostic factors and survival rate. An 11-year single centre experience.
abstract: BACKGROUND
  This report examines the patterns of presentation, prognostic factors and survival rate of all patients with gallbladder cancer (GBC) evaluated at our tertiary academic hospital over an 11-year period.
  
  
  METHODS
  A retrospective review of a prospectively collected database of all patients with GBC presenting between January 1998 and December 2008 was performed.
  
  
  RESULTS
  102 GBC-patients were included: 69 women and 33 men (median age: 65,5 years). Forty-five patients presented with incidental gallbladder cancer (IGC) and 57 with nonincidental cancer (NIGC). Curative surgery rate was 84.4% for IGC and 29.8% for NIGC (p < 0.001). Five-year actuarial survival rate was 63.2% for patients with curative intent surgery and 0% for patients with palliative approach. Patients with IGC had a longer survival rate compared to patients with NIGC (median: 25.8 vs. 4.4 months, p < 0.0001). For patients with radical resection (42 patients), there was no difference between IGC and NIGC. The incidence of liver involvement was respectively 0%, 20.8%, 58.3%, 100% for pT1, pT2, pT3 and pT4 tumors. Univariate analysis showed that survival rate was significantly affected by perineural invasion, T, N and M-stage, R0 resection, liver involvement, CA-19.9. In multivariate analysis, liver involvement was the only independent factor.
  
  
  CONCLUSIONS
  Majority of patients with a potentially curable disease had IGC. Almost 80% of patients with NIGC presented with unresectable disease. For patients who underwent resection with curative intent, actuarial 5-year survival was 63.2%. Liver involvement was the only independent prognostic factor. All patients with IGC and a pT2 or more advanced T stage should undergo a second radical resection.
authors.affiliation: Hopital Saint Luc-CHUM, Service de chirurgie hépatobiliaire et pancréatique, Université de Montréal, Canada.
authors.forename: M
authors.initials: M
authors.lastname: D'Hondt
authors.forename: R
authors.initials: R
authors.lastname: Lapointe
authors.forename: Z
authors.initials: Z
authors.lastname: Benamira
authors.forename: H
authors.initials: H
authors.lastname: Pottel
authors.forename: M
authors.initials: M
authors.lastname: Plasse
authors.forename: R
authors.initials: R
authors.lastname: Letourneau
authors.forename: A
authors.initials: A
authors.lastname: Roy
authors.forename: M
authors.initials: M
authors.lastname: Dagenais
authors.forename: F
authors.initials: F
authors.lastname: Vandenbroucke-Menu
mesh_terms: D000206:Actuarial Analysis; D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000175:diagnosis* / Q000401:mortality* / Q000556:secondary / Q000601:surgery; D002763:Cholecystectomy; D005260:Female; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate