Impact of Chemotherapy and External-Beam Radiation Therapy on Outcomes among Patients with Resected Gallbladder Cancer

A Multi-institutional Analysis

Yuhree Kim, Neda Amini, Ana Wilson, Georgios A. Margonis, Cecilia G. Ethun, George Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Bradley Krasnick, Sharon M. Weber, Ahmed Salem, Robert C G Martin, Charles Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza Beal, Ioannis Hatzaras & 4 others Rivfka Shenoy, Kenneth Cardona, Shishir K. Maithel, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: Use of adjuvant chemotherapy (CTx) and chemoradiation therapy (cXRT) for the treatment of gallbladder cancer (GBC) remains varied. We sought to define the utilization and effect of adjuvant therapy for patients with GBC. Methods: Using a multi-institutional national database, 291 patients with GBC who underwent curative-intent resection between 2000 and 2015 were included. Patients with metastasis or an R2 margin were excluded. Results: Median patient age was 66.6 years. Most patients had a T2 (46.2 %) or T3 (38.6 %) lesion, and 37.8 % of patients had lymph node (LN) metastasis. A total of 186 (63.9 %) patients underwent surgery alone, 61 (21.0 %) received CTx, and 44 (15.1 %) patients received cXRT. On multivariable analysis, factors associated with worse overall survival (OS) included T3/T4 stage [hazard ratio (HR) 1.82], LN-metastasis (HR 1.84), lymphovascular invasion (HR 2.02), perineural invasion (HR 1.42), and R1 surgical margin status (HR 2.06); all P <0.05). In contrast, receipt of CTx/cXRT was associated with improved OS (CTx, HR 0.38; cXRT, HR 0.26; P <0.001) compared with surgery alone. Similar results were observed for disease-free survival (DFS) (CTx, HR 0.61; cXRT, HR 0.43; P <0.05). Of note, only patients with high-risk features, such as AJCC T3/T4 stage (HR 0.41), LN metastasis (HR 0.45), and R1 disease (HR 0.21) (all P <0.05) derived an OS benefit from CTx/cXRT. Conclusions: Adjuvant CTx/cXRT was utilized in 36 % of patients undergoing curative-intent resection for GBC. After adjusted analyses, CTx/cXRT were independently associated with improved long-term outcomes, but the benefit was isolated to only patients with high-risk characteristics.

Original languageEnglish (US)
Pages (from-to)1-11
Number of pages11
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - May 11 2016

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Gallbladder Neoplasms
Radiotherapy
Drug Therapy
Neoplasm Metastasis
Therapeutics
Lymph Nodes
Survival
Adjuvant Chemotherapy
Disease-Free Survival

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Impact of Chemotherapy and External-Beam Radiation Therapy on Outcomes among Patients with Resected Gallbladder Cancer : A Multi-institutional Analysis. / Kim, Yuhree; Amini, Neda; Wilson, Ana; Margonis, Georgios A.; Ethun, Cecilia G.; Poultsides, George; Tran, Thuy; Idrees, Kamran; Isom, Chelsea A.; Fields, Ryan C.; Krasnick, Bradley; Weber, Sharon M.; Salem, Ahmed; Martin, Robert C G; Scoggins, Charles; Shen, Perry; Mogal, Harveshp D.; Schmidt, Carl; Beal, Eliza; Hatzaras, Ioannis; Shenoy, Rivfka; Cardona, Kenneth; Maithel, Shishir K.; Pawlik, Timothy M.

In: Annals of Surgical Oncology, 11.05.2016, p. 1-11.

Research output: Contribution to journalArticle

Kim, Y, Amini, N, Wilson, A, Margonis, GA, Ethun, CG, Poultsides, G, Tran, T, Idrees, K, Isom, CA, Fields, RC, Krasnick, B, Weber, SM, Salem, A, Martin, RCG, Scoggins, C, Shen, P, Mogal, HD, Schmidt, C, Beal, E, Hatzaras, I, Shenoy, R, Cardona, K, Maithel, SK & Pawlik, TM 2016, 'Impact of Chemotherapy and External-Beam Radiation Therapy on Outcomes among Patients with Resected Gallbladder Cancer: A Multi-institutional Analysis', Annals of Surgical Oncology, pp. 1-11. https://doi.org/10.1245/s10434-016-5262-8
Kim, Yuhree ; Amini, Neda ; Wilson, Ana ; Margonis, Georgios A. ; Ethun, Cecilia G. ; Poultsides, George ; Tran, Thuy ; Idrees, Kamran ; Isom, Chelsea A. ; Fields, Ryan C. ; Krasnick, Bradley ; Weber, Sharon M. ; Salem, Ahmed ; Martin, Robert C G ; Scoggins, Charles ; Shen, Perry ; Mogal, Harveshp D. ; Schmidt, Carl ; Beal, Eliza ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Cardona, Kenneth ; Maithel, Shishir K. ; Pawlik, Timothy M. / Impact of Chemotherapy and External-Beam Radiation Therapy on Outcomes among Patients with Resected Gallbladder Cancer : A Multi-institutional Analysis. In: Annals of Surgical Oncology. 2016 ; pp. 1-11.
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abstract = "Background: Use of adjuvant chemotherapy (CTx) and chemoradiation therapy (cXRT) for the treatment of gallbladder cancer (GBC) remains varied. We sought to define the utilization and effect of adjuvant therapy for patients with GBC. Methods: Using a multi-institutional national database, 291 patients with GBC who underwent curative-intent resection between 2000 and 2015 were included. Patients with metastasis or an R2 margin were excluded. Results: Median patient age was 66.6 years. Most patients had a T2 (46.2 {\%}) or T3 (38.6 {\%}) lesion, and 37.8 {\%} of patients had lymph node (LN) metastasis. A total of 186 (63.9 {\%}) patients underwent surgery alone, 61 (21.0 {\%}) received CTx, and 44 (15.1 {\%}) patients received cXRT. On multivariable analysis, factors associated with worse overall survival (OS) included T3/T4 stage [hazard ratio (HR) 1.82], LN-metastasis (HR 1.84), lymphovascular invasion (HR 2.02), perineural invasion (HR 1.42), and R1 surgical margin status (HR 2.06); all P <0.05). In contrast, receipt of CTx/cXRT was associated with improved OS (CTx, HR 0.38; cXRT, HR 0.26; P <0.001) compared with surgery alone. Similar results were observed for disease-free survival (DFS) (CTx, HR 0.61; cXRT, HR 0.43; P <0.05). Of note, only patients with high-risk features, such as AJCC T3/T4 stage (HR 0.41), LN metastasis (HR 0.45), and R1 disease (HR 0.21) (all P <0.05) derived an OS benefit from CTx/cXRT. Conclusions: Adjuvant CTx/cXRT was utilized in 36 {\%} of patients undergoing curative-intent resection for GBC. After adjusted analyses, CTx/cXRT were independently associated with improved long-term outcomes, but the benefit was isolated to only patients with high-risk characteristics.",
author = "Yuhree Kim and Neda Amini and Ana Wilson and Margonis, {Georgios A.} and Ethun, {Cecilia G.} and George Poultsides and Thuy Tran and Kamran Idrees and Isom, {Chelsea A.} and Fields, {Ryan C.} and Bradley Krasnick and Weber, {Sharon M.} and Ahmed Salem and Martin, {Robert C G} and Charles Scoggins and Perry Shen and Mogal, {Harveshp D.} and Carl Schmidt and Eliza Beal and Ioannis Hatzaras and Rivfka Shenoy and Kenneth Cardona and Maithel, {Shishir K.} and Pawlik, {Timothy M.}",
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T1 - Impact of Chemotherapy and External-Beam Radiation Therapy on Outcomes among Patients with Resected Gallbladder Cancer

T2 - A Multi-institutional Analysis

AU - Kim, Yuhree

AU - Amini, Neda

AU - Wilson, Ana

AU - Margonis, Georgios A.

AU - Ethun, Cecilia G.

AU - Poultsides, George

AU - Tran, Thuy

AU - Idrees, Kamran

AU - Isom, Chelsea A.

AU - Fields, Ryan C.

AU - Krasnick, Bradley

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Martin, Robert C G

AU - Scoggins, Charles

AU - Shen, Perry

AU - Mogal, Harveshp D.

AU - Schmidt, Carl

AU - Beal, Eliza

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Cardona, Kenneth

AU - Maithel, Shishir K.

AU - Pawlik, Timothy M.

PY - 2016/5/11

Y1 - 2016/5/11

N2 - Background: Use of adjuvant chemotherapy (CTx) and chemoradiation therapy (cXRT) for the treatment of gallbladder cancer (GBC) remains varied. We sought to define the utilization and effect of adjuvant therapy for patients with GBC. Methods: Using a multi-institutional national database, 291 patients with GBC who underwent curative-intent resection between 2000 and 2015 were included. Patients with metastasis or an R2 margin were excluded. Results: Median patient age was 66.6 years. Most patients had a T2 (46.2 %) or T3 (38.6 %) lesion, and 37.8 % of patients had lymph node (LN) metastasis. A total of 186 (63.9 %) patients underwent surgery alone, 61 (21.0 %) received CTx, and 44 (15.1 %) patients received cXRT. On multivariable analysis, factors associated with worse overall survival (OS) included T3/T4 stage [hazard ratio (HR) 1.82], LN-metastasis (HR 1.84), lymphovascular invasion (HR 2.02), perineural invasion (HR 1.42), and R1 surgical margin status (HR 2.06); all P <0.05). In contrast, receipt of CTx/cXRT was associated with improved OS (CTx, HR 0.38; cXRT, HR 0.26; P <0.001) compared with surgery alone. Similar results were observed for disease-free survival (DFS) (CTx, HR 0.61; cXRT, HR 0.43; P <0.05). Of note, only patients with high-risk features, such as AJCC T3/T4 stage (HR 0.41), LN metastasis (HR 0.45), and R1 disease (HR 0.21) (all P <0.05) derived an OS benefit from CTx/cXRT. Conclusions: Adjuvant CTx/cXRT was utilized in 36 % of patients undergoing curative-intent resection for GBC. After adjusted analyses, CTx/cXRT were independently associated with improved long-term outcomes, but the benefit was isolated to only patients with high-risk characteristics.

AB - Background: Use of adjuvant chemotherapy (CTx) and chemoradiation therapy (cXRT) for the treatment of gallbladder cancer (GBC) remains varied. We sought to define the utilization and effect of adjuvant therapy for patients with GBC. Methods: Using a multi-institutional national database, 291 patients with GBC who underwent curative-intent resection between 2000 and 2015 were included. Patients with metastasis or an R2 margin were excluded. Results: Median patient age was 66.6 years. Most patients had a T2 (46.2 %) or T3 (38.6 %) lesion, and 37.8 % of patients had lymph node (LN) metastasis. A total of 186 (63.9 %) patients underwent surgery alone, 61 (21.0 %) received CTx, and 44 (15.1 %) patients received cXRT. On multivariable analysis, factors associated with worse overall survival (OS) included T3/T4 stage [hazard ratio (HR) 1.82], LN-metastasis (HR 1.84), lymphovascular invasion (HR 2.02), perineural invasion (HR 1.42), and R1 surgical margin status (HR 2.06); all P <0.05). In contrast, receipt of CTx/cXRT was associated with improved OS (CTx, HR 0.38; cXRT, HR 0.26; P <0.001) compared with surgery alone. Similar results were observed for disease-free survival (DFS) (CTx, HR 0.61; cXRT, HR 0.43; P <0.05). Of note, only patients with high-risk features, such as AJCC T3/T4 stage (HR 0.41), LN metastasis (HR 0.45), and R1 disease (HR 0.21) (all P <0.05) derived an OS benefit from CTx/cXRT. Conclusions: Adjuvant CTx/cXRT was utilized in 36 % of patients undergoing curative-intent resection for GBC. After adjusted analyses, CTx/cXRT were independently associated with improved long-term outcomes, but the benefit was isolated to only patients with high-risk characteristics.

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