Pattern of Care and Outcomes of Gallbladder Cancer Patients: Retrospective Study from a High Incidence Region in India

Abstract

Lakhan Kasyap

Introduction Gallbladder cancer (GBC) is the 20th most common cancer in India with a crude incidence rate of 2.3 per 100,000 persons. Of note, it is relatively common in states which fall in the Gangetic plains. Patients often present in the advanced stage and have an unfavorable prognosis.

Materials and Methods From January to June 2021, 170 treatment-naive GBC (adenocarcinoma) patients who were registered at a tertiary care cancer center in North India, were included. Data were extracted from electronic medical records and was analyzed with SPSS.

Results Median age was 56 years (range 32–77 years) and 65.5% (n = 112) were female. Incidental GBC was found in 20% patient (n = 34). Majority of patients (79.4%, n = 135) had preserved performance status. Advanced GBC was present in 85.8% (n = 146) patients (locally advanced = 37.0% and metastatic = 48.8%). Biliary drainage procedure was performed in 24% of patients (68% of patients with obstructive jaundice). More than half of patients (53.5%) were lost to follow-up without any treatment. There were 33 patients (19.4%) who underwent surgery and 20 of them received neoadjuvant chemotherapy. Adjuvant chemotherapy and adjuvant radiotherapy were received by 13 and 2 patients, respectively. Palliative chemotherapy was administered to 46 patients. The most common chemotherapy regimen was gemcitabine-cisplatin. At a median follow-up of 1.7 months (95% confidence interval, 1–2.4 months), 42 patients (24%) progressed and 24 patients (14%) died, with 6 months estimated progression-free survival and overall survival being 60.2 and 79%, respectively.

Conclusion GBC is an aggressive and lethal malignancy predominantly affecting females in the fifth decade with dismal outcomes. Improved access to health care, an aggressive approach in operable cases, and optimization of systemic and adjuvant therapy are the need of the hour.

Keywords

gallbladder cancer - high incident region - outcome - pattern of care - retrospective

Publication History

Article published online:
11 August 2023

• References

• 1 Batra Y, Pal S, Dutta U. et al. Gallbladder cancer in India: a dismal picture. J Gastroenterol Hepatol 2005; 20 (02) 309-314
• 2 Levy AD, Murakata LA, Rohrmann Jr CA. Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics 2001; 21 (02) 295-314 , 549–555
• 3 356-india-fact-sheets.pdf [Internet]. Accessed October 17, 2022, at: https://gco.iarc.fr/today/data/factsheets/populations/356-india-fact-sheets.pdf
• 4 Mathur P, Sathishkumar K, Chaturvedi M. et al; ICMR-NCDIR-NCRP Investigator Group. Cancer Statistics, 2020: report from National Cancer Registry Programme, India. JCO Glob Oncol 2020; 6: 1063-1075
• 5 Acharya MR, Patkar S, Parray A, Goel M. Management of gallbladder cancer in India. Chin Clin Oncol 2019; 8 (04) 35
• 6 Shirai Y, Yoshida K, Tsukada K, Muto T, Watanabe H. Radical surgery for gallbladder carcinoma. Long-term results. Ann Surg 1992; 216 (05) 565-568
• 7 Buettner S, Margonis GA, Kim Y. et al. Changing odds of survival over time among patients undergoing surgical resection of gallbladder carcinoma. Ann Surg Oncol 2016; 23 (13) 4401-4409
• 8 Kim WS, Choi DW, You DD, Ho CY, Heo JS, Choi SH. Risk factors influencing recurrence, patterns of recurrence, and the efficacy of adjuvant therapy after radical resection for gallbladder carcinoma. J Gastrointest Surg 2010; 14 (04) 679-687
• 9 Jarnagin WR, Ruo L, Little SA. et al. Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer 2003; 98 (08) 1689-1700
• 10 Gupta P, Meghashyam K, Marodia Y. et al. Locally advanced gallbladder cancer: a review of the criteria and role of imaging. Abdom Radiol (NY) 2021; 46 (03) 998-1007
• 11 Dutta U, Bush N, Kalsi D, Popli P, Kapoor VK. Epidemiology of gallbladder cancer in India. Chin Clin Oncol 2019; 8 (04) 33
• 12 Madhawi R, Pandey A, Raj S. et al. Geographical pattern of carcinoma gallbladder in Bihar and its association with river Ganges and arsenic levels: Retrospective individual consecutive patient data from Regional Cancer Centre. South Asian J Cancer 2018; 7 (03) 167-170
• 13 Lai CHE, Lau WY. Gallbladder cancer–a comprehensive review. Surgeon 2008; 6 (02) 101-110
• 14 Valle JW, Borbath I, Khan SA, Huguet F, Gruenberger T, Arnold D. ESMO Guidelines Committee. Biliary cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2016; 27 (Suppl. 05) v28-v37
• 15 Pati S, Hussain MA, Chauhan AS, Mallick D, Nayak S. Patient navigation pathway and barriers to treatment seeking in cancer in India: a qualitative inquiry. Cancer Epidemiol 2013; 37 (06) 973-978
• 16 Krell RW, Wei AC. Gallbladder cancer: surgical management. Chin Clin Oncol 2019; 8 (04) 36
• 17 Dotan E, Tew WP, Mohile SG. et al. Associations between nutritional factors and chemotherapy toxicity in older adults with solid tumors. Cancer 2020; 126 (08) 1708-1716
• 18 Valle J, Wasan H, Palmer DH. et al; ABC-02 Trial Investigators. Cisplatin plus gemcitabine versus gemcitabine for biliary tract cancer. N Engl J Med 2010; 362 (14) 1273-1281
• 19 Okusaka T, Nakachi K, Fukutomi A. et al. Gemcitabine alone or in combination with cisplatin in patients with biliary tract cancer: a comparative multicentre study in Japan. Br J Cancer 2010; 103 (04) 469-474
• 20 Sharma A, Dwary AD, Mohanti BK. et al. Best supportive care compared with chemotherapy for unresectable gall bladder cancer: a randomized controlled study. J Clin Oncol 2010; 28 (30) 4581-4586
• 21 Chaudhari VA, Ostwal V, Patkar S. et al. Outcome of neoadjuvant chemotherapy in “locally advanced/borderline resectable” gallbladder cancer: the need to define indications. HPB (Oxford) 2018; 20 (09) 841-847
• 22 Zhu X, Zhang X, Hu X. et al. Survival analysis of patients with primary gallbladder cancer from 2010 to 2015: a retrospective study based on SEER data. Medicine (Baltimore) 2020; 99 (40) e22292
• 23 Ramaswamy A, Ostwal V, Pande N. et al. Second-line palliative chemotherapy in advanced gall bladder cancer, CAP-IRI: safe and effective option. J Gastrointest Cancer 2016; 47 (03) 305-312
• 24 Ramaswamy A, Ostwal V, Sharma A. et al. Efficacy of capecitabine plus irinotecan vs irinotecan monotherapy as second-line treatment in patients with advanced gallbladder cancer: a multicenter phase 2 randomized clinical trial (GB-SELECT). JAMA Oncol 2021; 7 (03) 436-439
• 25 Bakhshi S. Treating children with cancer in India - navigating unique challenges. EBioMedicine 2021; 63: 103199