Tumor location is a strong predictor of tumor progression and survival in T2 gallbladder cancer: an international multicenter study.
OBJECTIVE
To determine the prognostic impact of tumor location in gallbladder cancer.


BACKGROUND
Depth of tumor is a strong predictor of survival after curative resection of gallbladder cancer. However, the gallbladder has a unique anatomical relationship with the liver, and the clinical significance of tumor location remains unclear.


METHODS
For 437 patients with gallbladder cancer who underwent resection at 4 international institutions, clinicopathologic characteristics and their association with survival were analyzed. Tumor location was defined as "hepatic side" or "peritoneal side," and the prognostic significance of tumor location was evaluated.


RESULTS
Among the 252 patients with T2 disease, patients with tumors on the hepatic side (T2h, n = 99) had higher rates of vascular invasion, neural invasion, and nodal metastasis than patients with tumors on the peritoneal side (T2p, n = 153) (51% vs 19%, 33% vs 8%, and 40% vs 17%, respectively; P < 0.01 for all). After a median follow-up of 58.9 months, 3-year and 5-year survival rates were 52.1% and 42.6%, respectively, for T2h tumors and 73.7% and 64.7%, respectively, for T2p tumors (P = 0.0006). No such differences were observed in T1 or T3 tumors. Multivariate analysis confirmed the independent association of hepatic-side location with survival in T2 tumors (hazard ratio, 2.7; 95% confidence interval, 1.7-4.2; P < 0.001). This subclassification of T2 tumors predicted recurrence in the liver (23% vs 3%; P = 0.003) and distant lymph nodes (16% vs 3%; P = 0.019) even after radical resection.


CONCLUSIONS
After curative resection of T2 gallbladder cancer, tumor location predicts the pattern of recurrence and survival.
*Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX †Hepato-biliary-pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan ‡Department of Surgery, Clinica Alemana Santiago, Vitacura, Santiago, Chile §Department of Pathology, Pontificia Universidad Católica, Santiago, Chile ‖Creative Bioscience, Santiago, Chile ¶Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Turin, Italy **Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX ††Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX.
Junichi
J
Shindoh
Xabier
X
de Aretxabala
Thomas A
TA
Aloia
Juan Carlos
JC
Roa
Ivan
I
Roa
Giuseppe
G
Zimmitti
Milind
M
Javle
Claudius
C
Conrad
Dipen M
DM
Maru
Taku
T
Aoki
Luca
L
Vigano
Dario
D
Ribero
Norihiro
N
Kokudo
Lorenzo
L
Capussotti
Jean-Nicolas
JN
Vauthey
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D038622:Internationality; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D015996:Survival Rate; D016896:Treatment Outcome