title: Improvement of clinical outcomes in the patients with gallbladder cancer: lessons from periodic comparison in a tertiary referral center.
abstract: BACKGROUND
  Current guidelines for gallbladder cancer (GBC) contain controversies and some reported no survival improvement in GBC during 20 years. This study was designed to explore the chronologic change of survival outcomes in GBC and prognostic factors.
  
  
  METHODS
  Clinicopathologic features and survival outcomes were analyzed in 692 consecutive GBC patients who underwent surgery between 1987 and 2014, including 255 treated in Period (P) 1 (1987-2000) and 437 in P2 (2001-2014).
  
  
  RESULTS
  The mean age was 63.3 years. Curative resection rate was 59.2% and 5-year survival rate (5-YSR) after curative resection was 67.1%. Comparisons between P1 and P2 showed that mean age, asymptomatic presentation, extended cholecystectomy, curative resection, adjuvant chemotherapy, and tumor ≤ T2 were significantly higher during P2. The overall 5-YSR after curative surgery was significantly lower in P1. In patients who underwent curative resection, poor prognostic factors included symptomatic presentation, CA 19-9 >37 IU/ml, poor differentiation, tumor ≥ T3, and lymph nodal involvement. In patients who received non-curative surgery, well- or moderately differentiated tumor and adjuvant chemotherapy provide survival benefit.
  
  
  CONCLUSIONS
  Detection of GBC at an early stage and optimal curative surgery may improve survival outcomes in GBC. Chemotherapy provides survival benefit in palliative setting.
authors: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea.
authors: Jihoon
authors: J
authors: Chang
authors: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea. jangjy4@gmail.com.
authors: Jin-Young
authors: JY
authors: Jang
authors: Department of Pathology, Seoul National University College of Medicine, Seoul, Korea.
authors: Kyoung Bun
authors: KB
authors: Lee
authors: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea.
authors: Mee Joo
authors: MJ
authors: Kang
authors: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea.
authors: Woohyun
authors: W
authors: Jung
authors: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea.
authors: Yong Chan
authors: YC
authors: Shin
authors: Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, 101 Daehak-Ro, Jongro-Gu, Seoul 110-744, Korea.
authors: Sun-Whe
authors: SW
authors: Kim
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000556:secondary / Q000628:therapy*; D059186:Chemoradiotherapy, Adjuvant; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome
keywords: Gallbladder neoplasms; Treatment outcome