Ann Hepatobiliary Pancreat Surg.  2024 Nov;28(4):474-482. 10.14701/ahbps.24-117.

Impact of longitudinal tumor location on postoperative outcomes in gallbladder cancer: Fundus and body vs. neck and cystic duct, a retrospective multicenter study

• Kim KH
• Moon JI
• Park JW
• You Y
• Jung HI
• Choi H
• Hwang SE
• Jo S

• KMID: 2561580
• DOI: http://doi.org/10.14701/ahbps.24-117

Abstract

Backgrounds/Aims
Systematic investigations into the prognostic impact of the longitudinal tumor location in gallbladder cancer (GBC) remain insufficient. To address the limitations of our pilot study, we conducted a multicenter investigation to clarify the impact of the longitudinal tumor location on the oncological outcomes of GBC.
Methods
A retrospective multicenter study was conducted on 372 patients undergoing radical resections for GBC from January 2010 to December 2019 across seven hospitals that belong to the Daejeon–Chungcheong branch of the Korean Association of Hepato-Biliary-Pancreatic Surgery. Patients were divided into GBC in the fundus/body (FB-GBC) and GBC in the neck/cystic duct (NC-GBC) groups, based on the longitudinal tumor location.
Results
Of 372 patients, 282 had FB-GBC, while 90 had NC-GBC. NC-GBC was associated with more frequent elevation of preoperative carbohydrate antigen (CA) 19-9 levels, requirement for more extensive surgery, more advanced histologic grade and tumor stages, more frequent lymphovascular and perineural invasion, lower R0 resection rates, higher recurrence rates, and worse 5-year overall and disease-free survival rates. Propensity score matching analysis confirmed these findings, showing lower R0 resection rates, higher recurrence rates, and worse survival rates in the NC-GBC group. Multivariate analysis identified elevated preoperative CA 19-9 levels, lymph node metastasis, and non-R0 resection as independent prognostic factors, but not longitudinal tumor location.
Conclusions
NC-GBC exhibits more frequent elevation of preoperative CA 19-9 levels, more advanced histologic grade and tumor stages, lower R0 resection rates, and poorer overall and disease-free survival rates, compared to FB-GBC. However, the longitudinal tumor location was not analyzed as an independent prognostic factor.

Keyword

Gallbladder neoplasms; Neoplasms by site; Prognosis

Figure

• 

  Fig. 1 Flow diagram of the analysis. A total of 427 patients were enrolled in this study. Based on the exclusion criteria, 55 patients were excluded for several reasons, and ultimately, data on 372 patients were analyzed. Because pT1 stage exhibits a low recurrence rate and good prognosis, further analysis was conducted on the patients with pT2–4 stages, excluding these 100 pT1 stage patients. Propensity score matching for pT-stage, pN-stage, and histologic grade was used to correct the imbalance in this study, and resulted in the creation of 74 patient pairs. FB-GBC, gallbladder cancer in the fundus/body; NC-GBC, gallbladder cancer in the neck/cystic duct; PSM, propensity score matching.

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  Fig. 2 The anatomical division of the gallbladder. We chose the guidelines of the Japanese Society of Hepato-Biliary-Pancreatic Surgery as the division criteria. Patients were classified into gallbladder cancer in the fundus/body and gallbladder cancer in the neck/cystic duct groups, based on the longitudinal tumor location.

• 

  Fig. 3 Overall survival (A) and disease-free survival (B) of FB-GBC and NC-GBC for all patients (n = 372). The NC-GBC group showed a significant poor prognosis in the 5-year overall survival rate (76.7% vs. 45.0%, p < 0.001) and disease-free survival rate (68.7% vs. 25.0%, p < 0.001), compared to the FB-GBC group. FB-GBC, gallbladder cancer in the fundus/body; NC-GBC, gallbladder cancer in the neck/cystic duct; 5-YSR, 5-year survival rate.

• 

  Fig. 4 Overall survival (A) and disease-free survival (B) of FB-GBC and NC-GBC for the patients with pT2–4 stages (n = 272). Similar to the survival outcomes in patients with all stages, the 5-year overall survival rate (69.5% vs. 36.2%, p < 0.001) and disease-free survival rate (58.4% vs. 19.8%, p < 0.001) were significantly higher in the FB-GBC patients. FB-GBC, gallbladder cancer in the fundus/body; NC-GBC, gallbladder cancer in the neck/cystic duct; 5-YSR, 5-year survival rate.

• 

  Fig. 5 Overall survival (A) and disease-free survival (B) of FB-GBC and NC-GBC after propensity score matching (n = 148). Even after adopting propensity score matching, the survival outcomes between the two groups were still significantly different; the 5-year overall survival rate (74.3% vs. 44.1%, p = 0.002) and disease-free survival rate (58.3% vs. 21.6%, p < 0.001) were lower in the NC-GBC group. FB-GBC, gallbladder cancer in the fundus/body; NC-GBC, gallbladder cancer in the neck/cystic duct; 5-YSR, 5-year survival rate.

Reference

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