Date of Award
Spring 5-12-2017
Degree Type
Thesis
Degree Name
Master of Public Health (MPH)
Department
Public Health
First Advisor
Dora Il'yasova
Second Advisor
Shishir Maithel
Third Advisor
Cecilia Ethun
Abstract
BACKGROUND
Most gallbladder cancers (GBC) are discovered incidentally after routine cholecystectomy. The relationship between the method of diagnosis and disease stage, treatment, and prognosis are not known.
METHODS
Patients with GBC who underwent resection at 10 institutions from 2000-2015 were included. Patients diagnosed incidentally (IGBC) and non-incidentally (non-IGBC) were compared. Primary outcome was overall survival (OS).
RESULTS
Of 445 patients with GBC, 266 (60%) were IGBC and 179 (40%) were non-IGBC. Compared to IGBC, non-IGBC patients were more likely to have R2 (macroscopic residual disease) resections (43 vs. 19%; p<0.001), advanced tumor (T) stage (T3/T4: 70 vs. 40%; p<0.001), high grade tumors (50 vs. 31%; p<0.001), lymphovascular invasion (LVI: 64 vs. 45%; p=0.01), and positive lymph nodes (LN: 60 vs. 43%; p=0.009). Receipt of adjuvant chemotherapy was similar between the groups (49 vs. 49%). Non-IGBC was associated with worse median OS compared to IGBC (17 vs. 32 months, p<0.001), which persisted among Stage III patients (12 vs. 29 months; p<0.001), but not Stages I, II or IV. After adjustment of other adverse pathologic factors (grade, T-stage, LVI, margin, LN), adjuvant chemotherapy was associated with improved OS only in Stage III IGBC but not in non-IGBC.
CONCLUSION
Compared to incidental discovery, non-incidental gallbladder cancer is associated with reduced overall survival, which is most evident in Stage III disease. Despite being well-matched for other adverse pathologic factors, adjuvant chemotherapy was associated with improved survival only in Stage III patients with incidentally discovered cancer. This underscores the importance of method of diagnosis in gallbladder cancer and suggests that these two groups may represent a distinct biology of disease, and the same treatment paradigm may not be appropriate.
DOI
https://doi.org/10.57709/10082302
Recommended Citation
Le, Nina, "Pathologic and Prognostic Implications of Incidental vs. Non-Incidental Gallbladder Cancer: A 10-Institution Study from the U.S. Extrahepatic Biliary Consortium." Thesis, Georgia State University, 2017.
doi: https://doi.org/10.57709/10082302