Prognosis factors of survival of gallbladder cancer (GC) in Chile. A retrospective analysis of patients assisted in Hospital Clínico Universidad de Chile

Abstract

Introduction: The GC is an aggressive neoplasmwith a short survival. The high lethality is associated with diagnosis in advanced stages due to the anatomical position and the mild and unspecific symptoms. Chile is the country with highest incidence and mortality rates of the GC in the world. The objective of the study was to determine the prognosis factors associated with the overall survival (OS) in patients with the diagnosis of GC. Methods: Retrospective study that includes patients with diagnosis of GC confirmed by biopsy, stratified according to images or surgical procedures. They were presented to the oncological committee joint during the period between January, 2010 to December, 2015. They were analyzed by demographic, clinical and pathological variables and related to the chemotherapeutic treatment received. Results: There were 61 patients, 42 women (68%) and 19 men (32%). The mean age was 61 years (35-83 years). Median albumin 3.5g/dl (1.2-4.6g/dl). Median hemoglobin: 12.0g/dl (7.1-16.5g/dl). The histopathological diagnosis was adenocarcinoma NOS in 75% of the cases. 64% of the patients debuted in IV stage. The liver was the most frequent metastasis localisation in 32% of cases. Twentyone patients (34%) received first line of chemotherapy. 90% of patients received gemcitabine with cisplatin, mean cycles was 5.5 cycles (1-19 cycles). The median OS was 10.9 months for the total group. The OS of patients that received first line of chemotherapy was 13.6 months (0.63-4,6 months). The OS was 2.8 moths in patients stage IV not treated with chemotherapy. In the multivariate analysis the factors that determined a better OS were ECOG: 0-1 versus ECOG ≤ 2 with OS 14.9 versus 2 months (HR 0.25, 95% CI 0,09-0,63; p 0,0001). Albumin ≤ 3,5 vs<3,5 g/dl with OS 11,8 vs 3,4 months respectively (HR 0,44, 95% CI 0,19-0,99; p=0,0185). In the group of patients treated with chemotherapy, the women reached a median OS 23,5 versus 13,5 months of men (HR 0,27, 95% CI 0,060-1,24; p=0,0239). There were non-statistically differences in the OS according to sex in the patients no treated with chemotherapy and according to IMC, hemoglobin, nor age in the global group. Conclusion: The GC is one of the most aggressive cancer with a short survival rate. In our analysis, the patients with an ECOG 0-1 and levels of albumin ≤ 3,5g/dl demonstrated a better OS due to the best nutritional and functional status of the patients. The women who received chemotherapy were also associated to a better prognosis. Probably this finding is related to an early consultation which would favor an earlier treatment.