Characteristics and outcomes of gallbladder cancer patients at the Tata Medical Center, Kolkata 2017-2019

Abstract

Background: The north and north-eastern regions of India have among the highest incidence of gallbladder cancer (GBC) in the world. We report the clinicopathological charateristics and outcome of GBC patients in India.

Methods: Electronic medical records of patients diagnosed with GBC at Tata Medical Center, Kolkata between 2017 and 2019 were analyzed.

Results: There were 698 cases of confirmed GBC with a median age of 58 (IQR: 50-65) years and female:male ratio of 1.96. At presentation, 91% (496/544) had stage III/IV disease and 30% (189/640) had incidental GBC. The 2-year overall survival (OS) was 100% (95% CI: 100-100); 61% (95% CI: 45-83); 30% (95% CI: 21-43); and 9% (95% CI: 6-13) for stages I-IV, respectively (p = <0.0001). For all patients, the 2-year OS in patients who had a radical cholecystectomy followed by adjuvant therapy (N = 36) was 50% (95% CI: 39-64), compared to 29% (95% CI: 22-38) for those who had a simple cholecystectomy and/or chemotherapy (N = 265) and 9% (95% CI: 6-14) in patients who were palliated (N = 107) (p = <0.0001).

Conclusion: The combined surgical/chemotherapy approach for patients with stage II GBC showed the best outcomes. Early detection of GBC remains problematic with the majority of patients presenting with stage III-IV and who have a median survival of 9.1 months. Our data suggests that the tumor is chemoresponsive and multi-center collaborative clinical trials to identify alternative therapies are urgently required.

Keywords: clinicopathology; electronic medical records; gallbladder cancer; treatment.

FIGURE 1

Identification of patients with gallbladder cancer from electronic medical records (EMR). Search term “gallbladder” excluding “benign cholecystitis”.

FIGURE 2

Kaplan–Meier survival analysis for (A) overall cohort (n = 466; median survival – 9.8 months); (B) stage I, II, III (median survival – 12.7 months), and IV (median survival – 6.8 months) sub‐cohorts; (C) sub‐cohorts who opted radical surgery (median survival – 24.6 months) and non‐radical surgery (median survival – 12.9 months); (D) sub‐cohorts, group 1 who opted for radical cholecystectomy along with chemotherapy (median survival – 19.4 months), group 2 who received sub‐optimal treatment that is, simple cholecystectomy along with chemotherapy or only chemotherapy (median survival – 11.5 months), and group 3 were palliative care group (median survival – 3.5 months).

FIGURE 3

(A) Box plot comparing median time to progression for stage II, III, and IV sub‐cohort; (B) Table describing number of patients in different sub‐groups of stage against disease response. Box Plot representation: Box denotes IQR (25%–75%) range; Horizontal line inside the box denotes median value; Whiskers represents 1.5*IQR; black dot represents an outlier.