Prognostic Insights and Survival Analysis of Gallbladder Cancer in Bihar, India: A Prospective Observational Study Emphasizing the Impact of Surgical Intervention on Overall Survival

Abstract

Abstract Purpose: The aim of this study was to determine the one- and three-year overall survival rates. Methods: This prospective observational study was conducted at a tertiary care center in Bihar state, India. Results: The study analyzed 228 patients in Bihar with a median age at diagnosis of 55 ± 12.05 years. The most common symptoms included upper abdominal pain (26.3%), weight loss (14%), and ascites (13.6%). The majority of patients presented at stage IV (72.8%), with liver metastasis being prevalent (61.4%). Interventional biliary drainage was performed in 9.6% of cases, and systemic chemotherapy was received by 84.64%, while 15.36% opted for best supportive care. Univariate Cox regression analysis identified Eastern Cooperative Oncology Group (ECOG) performance status, stage, gallstone disease, and surgical intervention as significant risk factors influencing overall survival (OS) (p<0.001). Multivariate Cox regression analysis confirmed ECOG performance status (p<0.001), stage (p=0.039), and surgical intervention (p=0.038) as independent factors impacting OS. One-year OS rates for stages II, III, and IV were 100%, 97%, and 44%, respectively, while three-year OS rates were 29%, 4%, and 0%. Surgical intervention significantly influenced OS (p<0.001). OS for surgical intervention was 28 months, and for inoperable cases, it was 12 months. One and three-year OS for surgical intervention were 95% and 11%, while for inoperable cases, they were 41% and 0%, respectively. Conclusion: Patients with gallbladder cancer, particularly in Bihar's Gangetic plains, face poor survival, especially with advanced disease. Adequate surgery improves outcomes, prompting a call for enhanced strategies, particularly for locally advanced GBC.