Adjuvant chemoradiation in resected gallbladder cancer: a prognostic index model for predicting overall survival

Abstract

PurposePatients with gallbladder cancer (GBC) have a dismal prognosis. We investigated outcomes and risk factors for overall survival (OS) in patients treated with radical surgery and adjuvant chemoradiotherapy (CRT).Materials/methodsA total of 212 patients with LAGC (pT3 59% and/or pN+ 52%) were studied. The primary endpoint of the analysis was OS. We constructed a risk scoring system in which points were assigned to each risk factor by dividing each beta coefficient in the final model by the lowest beta coefficient and rounding to the nearest integer. A risk score was assigned to each subject by adding up the points for each risk factor present. Subjects were then divided into three risk groups based on their risk scores (0 points=low risk, 1-2 points=intermediate risk, 3-6 points=high risk).ResultsMedian follow-up was 46.2months (2-235). Five-year OS for the entire cohort was 53%. In multivariate analysis, higher pT stage [HR, 2.43 (1.29-3.68); p=0.01], R1 resection [HR, 5.06 (3.12-8.19); p<0.001], and number of surgical procedures [HR, 1.41 (1.01-2.16); p=0.05] were associated with an increased risk of death. Five-year OS for patients with low (n=63), intermediate (n=94), and high (n=55) risk was 79.1%, 51.2%, and 9.5%, respectively.ConclusionOverall results after multimodality treatment of GBC are promising. A risk model was generated to determine a prognostic index for individual patients with GBC. Classification of risk factors for death has contributed to propose a prognostic index that could allow us to guide risk-adapted tailored treatment.