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Review
. 2021 Jul 28;10(15):3317.
doi: 10.3390/jcm10153317.

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis

Hyun Kang  1 , Yoo Shin Choi  2 , Suk-Won Suh  2 , Geunjoo Choi  1 , Jae Hyuk Do  3 , Hyoung-Chul Oh  3 , Hong Jin Kim  4 , Seung Eun Lee  2
Affiliations
Review

Prognostic Significance of Tumor Location in T2 Gallbladder Cancer: A Systematic Review and Meta-Analysis

Hyun Kang et al. J Clin Med. .

Abstract

(1) Background: The AJCC Cancer Staging Manual, Eighth Edition, subdivided T2 GBC into T2a and T2b. However, there still exist a lack of evidence on the prognostic significance of tumor location. The aim of the present study was to examine the existing evidence to determine the prognostic significance of tumor location of T2 gallbladder cancer (GBC) and to evaluate the optimal surgical extent according to tumor location. (2) Methods: We searched for relevant literature published in the electronic databases PubMed, MEDLINE, Web of Science, Cochrane Library, and Embase before September 2020 using search terms related to gallbladder, cancer, and stage. Data were weighted and pooled using random-effects modeling. (3) Results: Seven studies were deemed eligible for inclusion, representing a cohort of 1789 cases of resected T2 GBC. The overall survival for T2b tumor was significantly worse than that for T2a tumor (HR, 2.141; 95% confidence interval (CI), 1.140 to 4.023; I2 = 71.4%; Pchi2 = 0.007). The rate of lymph node metastasis was lower in the T2a group (26.6%) than in the T2b group (36.6%) (OR, 2.164; 95% CI, 1.309 to 3.575). There was no evidence of a survival difference between the patients who underwent extended cholecystectomy and simple cholecystectomy in T2a GBC (OR, 0.802; 95% CI, 0.618 to 1.042) and T2b GBC (OR, 0.820; 95% CI, 0.620 to 1.083). (4) Conclusions: Hepatic side tumor was a significant poor prognostic factor in T2 GBC. Extended cholecystectomy and simple cholecystectomy showed comparable survival outcomes in T2 GBC, and additional large-scale prospective studies are warranted to establish evidence-based treatment guidelines for T2 GBC.

Keywords: cancer; gallbladder; meta-analysis; prognosis; stage; survival.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram showing the number of abstracts and articles identified and evaluated during the review.
Figure 2
Figure 2
Forest plot of overall survival in resected T2a and T2b GBC patients. The figure depicts individual trials as filled squares with relative sample size and the 95% confidence interval (CI) of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect.
Figure 3
Figure 3
Forest plot of overall survival between extended cholecystectomy and simple cholecystectomy in T2a GBC patients. The figure depicts individual trials as filled squares with relative sample size and the 95% confidence interval (CI) of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect.
Figure 4
Figure 4
Forest plot of overall survival between extended cholecystectomy and simple cholecystectomy in T2b GBC patients. The figure depicts individual trials as filled squares with relative sample size and the 95% confidence interval (CI) of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect.
Figure 5
Figure 5
Forest plot of incidence of lymph node metastasis in T2a and T2b GBC patients. The figure depicts individual trials as filled squares with relative sample size and the 95% confidence interval (CI) of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect.
Figure 6
Figure 6
Forest plot of incidence of perineural invasion in T2a and T2b GBC patients. The figure depicts individual trials as filled squares with relative sample size and the 95% confidence interval (CI) of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect.
Figure 7
Figure 7
Forest plot of incidence of recurrence in T2a and T2b GBC patients. The figure depicts individual trials as filled squares with relative sample size and the 95% confidence interval (CI) of the difference as a solid line. The diamond shape indicates the pooled estimate and uncertainty for the combined effect.
See this image and copyright information in PMC

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