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Adjuvant radiotherapy improves long-term survival after resection for gallbladder cancer A population-based cohort study

Lookup NU author(s): Steven White

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Abstract

© 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. Background: Data supporting routine use of adjuvant radiotherapy (RT) compared to without RT (noRT) for gallbladder cancer (GBC) is unclear. This study aimed to determine whether RT improves long-term survival following resection for GBC. Methods: Patients receiving resection for GBC followed by RT from 2004 to 2016 were identified from the National Cancer Database (NCDB). Patients with survival <6 months were excluded to account for immortal time bias. Propensity score matching (PSM) and Cox regression was performed to account for selection bias and analyze impact of RT on overall survival. Results: Of 7514 (77%) noRT and 2261 (23%) RT, 2067 noRT and 2067 RT patients remained after PSM. After matching, RT was associated with improved survival (median: 26.2 vs 21.5 months, p < 0.001), which remained after multivariable adjustment (HR: 0.82, CI95%: 0.76–0.89, p < 0.001). On multivariable interaction analyses, this benefit persisted irrespective of nodal status: N0 (HR: 0.84, CI95%: 0.77–0.93), N1 (HR: 0.77, CI95%: 0.68–0.88), N2/N3 (HR: 0.56, CI95%: 0.35–0.91), margin status: R0 (HR: 0.85, CI95%: 0.78–0.93), R1 (HR: 0.78, CI95%: 0.68–0.88) and use of adjuvant chemotherapy (AC) (HR: 0.67, CI95%: 0.57–0.79). Benefit with RT were also seen in patients with T2 - T4 disease and in patients undergoing simple and extended cholecystectomy. Conclusion: RT following resection was associated with improved survival in this study, even in margin-negative and node-negative disease. These findings may suggest addition of RT into multimodality therapy for GBC.

Publication metadata

Author(s): Kamarajah SK, Al-Rawashdeh W, White SA, Abu Hilal M, Salti GI, Dahdaleh FS

Publication type: Article

Publication status: Published

Journal: European Journal of Surgical Oncology

Year: 2022

Volume: 48

Issue: 2

Pages: 425-434

Print publication date: 01/02/2022

Online publication date: 08/09/2021

Acceptance date: 01/09/2021

ISSN (print): 0748-7983

ISSN (electronic): 1532-2157

Publisher: Elsevier Ltd

URL: https://doi.org/10.1016/j.ejso.2021.09.002

DOI: 10.1016/j.ejso.2021.09.002

PubMed id: 34518052

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