Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 14, 2022; 28(18): 1996-2007
Published online May 14, 2022. doi: 10.3748/wjg.v28.i18.1996
Incidental gallbladder cancer diagnosis confers survival advantage irrespective of tumour stage and characteristics
Moath Alarabiyat, Syed Soulat Raza, John Isaac, Darius Mirza, Ravi Marudanayagam, Keith Roberts, Manuel Abradelo, David C Bartlett, Bobby V Dasari, Robert P Sutcliffe, Nikolaos A Chatzizacharias
Moath Alarabiyat, Syed Soulat Raza, John Isaac, Darius Mirza, Ravi Marudanayagam, Keith Roberts, Manuel Abradelo, David C Bartlett, Bobby V Dasari, Robert P Sutcliffe, HPB and Liver Transplant Unit, Queen Elizabeth Hospital, Birmingham B15 2GW, United Kingdom
Nikolaos A Chatzizacharias, Department of HPB and Liver Transplantation, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham B15 2TH, United Kingdom
Author contributions: Alarabiyat M and Raza SS are responsible for the data collection, statistical analysis, and wrote the manuscript; Alarabiyat M did the statistical analysis; Isaac J, Mirza DF, Marudanayagam R, Roberts K, Abradelo M, Bartlett DC, Dasari B, Sutcliffe BP are responsible for interpretation of data, manuscript revision and editing, approval of finalized version of the manuscript; Chatzizacharias N is responsible for developed research concept, writing, manuscript preparation, editing and review.
Institutional review board statement: The study was approved by the departmental ethics committee.
Informed consent statement: As this was an anonymised retrospective cohort study over a period of 12 years, individual consent forms were not required based on the policy of Queen Elizabeth Hospital and the UK on ethics and research.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
Data sharing statement: The original dataset is anonymized and available upon request from the corresponding author at Nikolaos.chatzizacharias@uhb.nhs.net.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikolaos A Chatzizacharias, FACS, FRCS, MD, PhD, Surgeon, Department of HPB and Liver Transplantation, Queen Elizabeth Hospital, University Hospitals Birmingham, Third Floor, Nuffield House, Mindelsohn Way, Birmingham B15 2TH, United Kingdom. chatzizacharias@gmail.com
Received: November 13, 2021
Peer-review started: November 13, 2021
First decision: January 9, 2022
Revised: January 22, 2022
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: May 14, 2022
Processing time: 179 Days and 20.6 Hours
Abstract
BACKGROUND

Incidental gallbladder cancer (IGBC) represents 50%-60% of gallbladder cancer cases. Data are conflicting on the role of IGBC diagnosis in oncological outcomes. Some studies suggest that IGBC diagnosis does not affect outcomes, while others that overall survival (OS) is longer in these cases compared to non-incidental diagnosis (NIGBC). Furthermore, some studies reported early tumour stages and histopathologic characteristics as possible confounders, while others not.

AIM

To investigate the role of IGBC diagnosis on patients’ overall survival, especially after surgical treatment with curative intent.

METHODS

Retrospective analysis of all patient referrals with gallbladder cancer between 2008 and 2020 in a tertiary hepatobiliary centre. Statistical comparison of patient and tumour characteristics between IGBC and NIGBC subgroups was performed. Survival analysis for the whole cohort, surgical and non-surgical subgroups was done with the Kaplan-Meier method and the use of log rank test. Risk analysis was performed with univariable and multivariable Cox regression analysis.

RESULTS

The cohort included 261 patients with gallbladder cancer. 65% of cases had NIGBC and 35% had IGBC. A total of 90 patients received surgical treatment (66% of IGBC cases and 19% of NIGBC cases). NIGBC patients had more advanced T stage and required more extensive resections than IGBC ones. OS was longer in patients with IGBC in the whole cohort (29 vs 4 mo, P < 0.001), as well as in the non-surgical (14 vs 2 mo, P < 0.001) and surgical subgroups (29 vs 16.5 mo, P = 0.001). Disease free survival (DFS) after surgery was longer in patients with IGBC (21.5 mo vs 8.5 mo, P = 0.007). N stage and resection margin status were identified as independent predictors of OS and DFS. NIGBC diagnosis was identified as an independent predictor of OS.

CONCLUSION

IGBC diagnosis may confer a survival advantage independently of the pathological stage and tumour characteristics. Prospective studies are required to further investigate this, including detailed pathological analysis and molecular gene expression.

Keywords: Gallbladder cancer; Incidental gallbladder cancer; Non-incidental gallbladder cancer; Gallbladder cancer survival

Core Tip: Data are conflicting on the role of incidental gallbladder cancer (IGBC) diagnosis in oncological outcomes. Some studies suggest that IGBC diagnosis does not affect outcomes, while others that overall survival (OS) is longer in these cases compared to non-incidental diagnosis (NIGBC). In our study, IGBC diagnosis conferred better OS in all patients with gallbladder cancer, as well as within the surgical and non-surgical groups. Similarly, disease free survival was significantly longer in patients with IGBC. NIGBC diagnosis was identified as an independent predictor of OS along with N stage and resection margin status.