Rayner P Cardoso, Eman Zineldin, Yara Sakr, Ali Abdelhady, Joshua J Horns, Courtney L Scaife, Marshall S Baker, Erin P Ward, T Clark Gamblin
Survival after resection of GBC remains poor. Margin-negative resection, nodal evaluation, adjuvant therapy, and treatment facility type were associated with outcomes. Chemotherapy use increased after BILCAP, but older patients remained less likely to receive postoperative therapy. These findings support improved surgical staging, greater adherence to adjuvant therapy guidelines, and multidisciplinary care for resected GBC.
BACKGROUND: Gallbladder cancer (GBC) is a rare but aggressive malignancy with poor long-term survival after resection. National data describing temporal changes in adjuvant therapy, surgical quality metrics, and facility-level outcomes remain limited.
METHODS: A retrospective cohort study was performed using the National Cancer Database from 2004 to 2022. Patients with primary GBC who underwent surgical resection and had no documented metastatic disease, T1a disease, or R2 resection were included. Adjuvant therapy was defined as chemotherapy and/or radiotherapy initiated within 90 days after surgery. Survival was estimated using Kaplan-Meier methods, and predictors of overall survival (OS) were evaluated using multivariable Cox proportional hazards regression.
RESULTS: A total of 31 812 patients were included. Median age was 65 years; 64.4% were older than 70 years, and 69.2% were female. Adenocarcinoma was the most common histology (74.2%). Median OS was 23.3 months, with 1-, 3-, and 5-year survival rates of 65.4%, 38.1%, and 26.4% respectively. R0 resection was associated with longer median OS than R1 resection (39.8 vs. 9.9 months; p < 0.001). Adjuvant chemotherapy increased from 24.8% before BILCAP to 32.7% after BILCAP, whereas radiotherapy decreased from 9.1% to 3.1% (both p < 0.001). Older patients were less likely to receive adjuvant therapy than younger patients (23.8% vs. 36.6%; p < 0.001). Academic centers had higher rates of R0 resection (69.4% vs. 64.3%), lymph node evaluation (59.9% vs. 42.9%), and ≥ 6-node examination (16.9% vs. 7.7%) compared with community facilities (all p < 0.001). In complete-case Cox regression, age > 65 years, lymph node positivity, larger tumor size, R1 margin, and treatment at non-academic facilities were associated with worse survival, whereas adjuvant therapy was associated with improved survival (HR: 0.82; 95% CI: 0.78-0.87).
CONCLUSIONS: Survival after resection of GBC remains poor. Margin-negative resection, nodal evaluation, adjuvant therapy, and treatment facility type were associated with outcomes. Chemotherapy use increased after BILCAP, but older patients remained less likely to receive postoperative therapy. These findings support improved surgical staging, greater adherence to adjuvant therapy guidelines, and multidisciplinary care for resected GBC.