Adjuvant therapy in the treatment of gallbladder cancer: a meta-analysis.
BACKGROUND
The benefit of adjuvant therapy (AT) for gallbladder cancer (GBC) is unclear as evidenced by conflicting results from nonrandomized studies. Here we aimed to perform a meta-analysis to determine the impact of AT on overall survival (OS).


METHODS
We used data from MEDLINE, EMBASE and the Cochrane Collaboration Library and published between October 1967 and October 2014. Studies that evaluated AT compared with curative-intent surgery alone for resected GBC were included. Subgroup analyses of benefit based on node status, margins status, and American Joint Committee on Cancer (AJCC) staging were prespecified. Data were weighted and pooled using random-effect modeling.


RESULTS
Ten retrospective studies involving 3,191 patients were analyzed. There was a nonsignificant improvement in OS with AT compared with surgery alone (hazard ratio [HR], 0.76; 95% confidence interval [CI], 0.56-1.03). A significant improvement was observed in OS with chemotherapy (CT) compared with surgery alone (HR, 0.42; 95% CI, 0.22-0.80) by sensitivity analysis. The greatest benefit for AT was also observed in those with R1 disease (HR, 0.33; 95% CI, 0.19-0.59), LN-positive disease (HR, 0.71; 95% CI, 0.63-0.81), and AJCC staging meeting or exceeding tumor Stage II (HR, 0.45; 95% CI, 0.26-0.79), but not in those with LN-negative or R0 disease.


CONCLUSIONS
Our results strongly support the use of CT as an AT in GBC. Moreover, patients with node positivity, margin positivity, or non-stage I disease are more likely to benefit from AT.
Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200041, China. mamimg@sina.com.|Clinical Laboratory, 85th Hospital of PLA, 1328 Huashan Road, Shanghai, 200052, China. mamimg@sina.com.
Ning
N
Ma
Department of Hematology, Changhai Hospital, the Second Military Medical University, Shanghai, 200433, China. chenghui19831103@163.com.
Hui
H
Cheng
Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200041, China. qbdchn11@126.com.
Baodong
B
Qin
Department of Laboratory Diagnostics, Changzheng Hospital, Second Military Medical University, 415 Fengyang Road, Shanghai, 200041, China. zhongrenqian@163.com.
Renqian
R
Zhong
Department of Oncology, Changhai Hospital, Second Military Medical University, 168 Changhai Road, Shanghai, 200433, China. qcwangb@163.com.
Bin
B
Wang
D000970:Antineoplastic Agents / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005706:Gallbladder Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006801:Humans; D012189:Retrospective Studies; D015996:Survival Rate
D000970:Antineoplastic Agents