Prognostic Factors in Patients Diagnosed with Gallbladder Cancer over a Period of 20 Years: A Cohort Study

Author:

Toussi Nima1,Daida Krishna1,Moser Michael12ORCID,Le Duc134,Hagel Kimberly135,Kanthan Rani16,Shaw John12,Zaidi Adnan134,Chalchal Haji135,Ahmed Shahid134ORCID

Affiliation:

1. College of Medicine, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada

2. Department of Surgery, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada

3. Department of Oncology, University of Saskatchewan, Saskatoon, SK S7N4H4, Canada

4. Saskatoon Cancer Center, Saskatoon, SK S7N4H4, Canada

5. Allan Blair Cancer Center, Regina, SK S4T7T1, Canada

6. Canada Department of Pathology, University of Saskatchewan, Saskatoon, SK S7N0W8, Canada

Abstract

Background: Gallbladder cancer (GBC) is an uncommon cancer. This study aimed to determine the outcomes of GBC in relation to geographic, demographic, and clinical factors in a Canadian province from 2000 to 2019. Methods: This population-based retrospective cohort study included all patients diagnosed with gallbladder cancer (GBC) in Saskatchewan, Canada, from 2000 to 2019. Cox proportional multivariate regression analysis was conducted to identify factors associated with poorer outcomes. Results: In total, 331 patients with a median age of 74 years and male–female ratio of 1:2 were identified. Of these patients, 305 (92%) had a pathological diagnosis of GBC. Among patients with documented staging data, 64% had stage IV disease. A total of 217 (66%) patients were rural residents, and 149 (45%) were referred to a cancer center. The multivariate analysis for patients with stage I–III GBC showed that stage III disease [hazard ratio (HR), 2.63; 95% confidence interval (CI), 1.09–6.34)] and urban residence (HR, 2.20; 95% CI, 1.1–4.39) were correlated with inferior disease-free survival. For all patients, stage IV disease (HR, 3.02; 95% CI, 1.85–4.94), no referral to a cancer center (HR, 2.64; 95% CI, 1.51–4.62), lack of surgery (HR, 1.63; 95% CI, 1.03–2.57), a neutrophil–lymphocyte ratio of >3.2 (HR, 1.57; 1.05–2.36), and age of ≥70 years (HR, 1.51; 95% CI, 1.04–2.19) were correlated with inferior overall survival. Conclusions: In this real-world context, the majority of patients with GBC were diagnosed at a late stage and were not referred to a cancer center. For those with early-stage GBC, living in an urban area and having stage III disease were linked to worse outcomes. Across all stages of GBC, stage IV disease, older age, absence of surgery, lack of referral to a cancer center, and a high neutrophil-to-lymphocyte ratio were associated with poorer survival.

Funder

Mach-Gaensslen Foundation of Canada

College of Medicine, University of Saskatchewan

Publisher

MDPI AG

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