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Comparative Study
. 2012 Jul;16(7):1311-7.
doi: 10.1007/s11605-012-1901-y. Epub 2012 May 9.

Tumor characteristics and survival analysis of incidental versus suspected gallbladder carcinoma

Laura M Mazer  1 , Hector F Losada, Rizwan M Chaudhry, Gabriela A Velazquez-Ramirez, John H Donohue, David A Kooby, David M Nagorney, N Volkan Adsay, Juan M Sarmiento
Affiliations
Comparative Study

Tumor characteristics and survival analysis of incidental versus suspected gallbladder carcinoma

Laura M Mazer et al. J Gastrointest Surg. 2012 Jul.

Abstract

Introduction: Over half of all gallbladder carcinoma (GBC) is discovered incidentally after cholecystectomy for benign disease. There are scant data comparing presentation and outcome for patients with incidental versus suspected GBC. The goal of this study is to determine the clinical differences between these two entities.

Study design: Patients with GBC were identified retrospectively from records at academic healthcare institutions in Temuco, Chile; Atlanta, GA; and Rochester, MN between 1984 and 2008. Overall survival was compared for patients with and without preoperative suspicion using Kaplan-Meier curves and a multivariate Cox proportional hazards model.

Results: Of 571 patients, 128 (22.4%) had preoperative suspicion of malignancy, and 443 (77.6 %) were discovered incidentally. Incidental tumors were of lower stage, better differentiated, and with lower rates of metastases. Median survival for incidentally discovered GBC was 32.3 versus 5.8 months for suspected GBC (p<0.0001). In a Cox proportional hazards model controlling for operation extent, T stage, differentiation, and other factors, preoperative suspicion remains a strong risk factor (odds ratio, 2.0; confidence interval, 1.5-2.9; p<0.0001).

Conclusions: Tumor characteristics differed significantly between patients with incidentally discovered versus preoperatively suspected GBC. Incidental GBC has a significantly better median survival.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier analysis of postoperative survival time in patients with GBC discovered incidentally (median survival, 32.3 months) versus GBC suspected on preoperative imaging (median survival, 5.8 months), log-rank test p<0.0001
Fig. 2
Fig. 2
Postoperative survival time in patients with stage T0–T1 GBC comparing incidental versus suspected disease, log-rank test p=0.0097
Fig. 3
Fig. 3
Postoperative survival time in patients with stage T2–T4 GBC comparing incidental versus suspected disease, log-rank test p<0.0001
Fig. 4
Fig. 4
Postoperative survival time in patients from Temuco, Chile comparing incidental versus suspected disease, log-rank test p<0.0001
Fig. 5
Fig. 5
Postoperative survival time in patients from American centers (Rochester, MN and Atlanta, GA) comparing incidental versus suspected disease, log-rank test p<0.0001
See this image and copyright information in PMC

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