Adjuvant Treatment for the Elderly Patient with Resected Gallbladder Cancer: a SEER-Medicare Analysis

Overview

Journal J Gastrointest Oncol

Date 2023 Jan 13

PMID 36636087

Authors

Elise de Savornin Lohman

Ali Belkouz

Usha Nuliyalu

Bas Groot Koerkamp

Heinz-Josef Klumpen

Philip de Reuver

Hari Nathan

Affiliations

Soon will be listed here.

Abstract

Background: In patients with resected gallbladder cancer (GBC), the role of adjuvant chemotherapy (aCT) remains ill-defined, especially in elderly patients. This study evaluates the value of aCT in elderly patients with GBC and assesses response according to tumor stage.

Methods: Patients of ≥65 years of age with resected GBC diagnosed from 2004-2015 were identified using a Surveillance, Epidemiology and End Results (SEER)/Medicare linked database. After propensity score matching, survival of patients treated with aCT was compared to survival of patients who did not receive aCT using Kaplan-Meier and Cox proportional hazards analysis.

Results: Of 2,179 patients with resected GBC, 876 (25%) received aCT. In the full cohort of 810 propensity-score matched patients, survival did not differ between patients treated with aCT (17.6 months ) and without aCT (19.5 months, P=0.7720). Subgroup analysis showed that survival was significantly better after aCT in T3/T4 disease (12.3 7.2 months, P=0.013). Interaction analysis showed that benefit of aCT was primarily seen in combined T3/T4, node-positive disease (HR 0.612 , P=0.006).

Conclusions: In this large cohort of elderly patients with resected GBC, aCT was not associated with increased survival. However, aCT may provide a survival benefit in T3/4, node-positive disease.

Citing Articles

Association between type 2 diabetes, alcohol intake frequency, age at menarche, and gallbladder cancer: a two-sample Mendelian randomization study.

Cheng M, Zhou X, Xue Y, Zhou E, Hu J, Xu J J Gastrointest Oncol. 2024; 15(3):1214-1223.

PMID: 38989400 PMC: 11231859. DOI: 10.21037/jgo-24-358.

Adjuvant Chemotherapy and Outcomes in Older Adult Patients With Biliary Tract Cancer.

Gbolahan O, Zhi X, Liu Y, Shah M, Kooby D, Alese O JAMA Netw Open. 2024; 7(1):e2351502.

PMID: 38206623 PMC: 10784855. DOI: 10.1001/jamanetworkopen.2023.51502.

References

Ebata T, Hirano S, Konishi M, Uesaka K, Tsuchiya Y, Ohtsuka M . Randomized clinical trial of adjuvant gemcitabine chemotherapy versus observation in resected bile duct cancer. Br J Surg. 2018; 105(3):192-202. DOI: 10.1002/bjs.10776. View

Shroff R, Kennedy E, Bachini M, Bekaii-Saab T, Crane C, Edeline J . Adjuvant Therapy for Resected Biliary Tract Cancer: ASCO Clinical Practice Guideline. J Clin Oncol. 2019; 37(12):1015-1027. DOI: 10.1200/JCO.18.02178. View

Primrose J, Fox R, Palmer D, Malik H, Prasad R, Mirza D . Capecitabine compared with observation in resected biliary tract cancer (BILCAP): a randomised, controlled, multicentre, phase 3 study. Lancet Oncol. 2019; 20(5):663-673. DOI: 10.1016/S1470-2045(18)30915-X. View

Austin S, Wong Y, Uzzo R, Beck J, Egleston B . Why Summary Comorbidity Measures Such As the Charlson Comorbidity Index and Elixhauser Score Work. Med Care. 2013; 53(9):e65-72. PMC: 3818341. DOI: 10.1097/MLR.0b013e318297429c. View

Weber S, DeMatteo R, Fong Y, Blumgart L, Jarnagin W . Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients. Ann Surg. 2002; 235(3):392-9. PMC: 1422445. DOI: 10.1097/00000658-200203000-00011. View

van Deudekom F, Postmus I, van der Ham D, Pothof A, Broekhuizen K, Blauw G . External validity of randomized controlled trials in older adults, a systematic review. PLoS One. 2017; 12(3):e0174053. PMC: 5367677. DOI: 10.1371/journal.pone.0174053. View

Saluja S, Nekarakanti P, Mishra P, Srivastava A, Singh K . Prospective Randomized Controlled Trial Comparing Adjuvant Chemotherapy vs. No Chemotherapy for Patients with Carcinoma of Gallbladder Undergoing Curative Resection. J Gastrointest Surg. 2021; 26(2):398-407. DOI: 10.1007/s11605-021-05143-6. View

Nagorney D, Donohue J, Farnell M, Schleck C, Ilstrup D . Outcomes after curative resections of cholangiocarcinoma. Arch Surg. 1993; 128(8):871-7; discussion 877-9. DOI: 10.1001/archsurg.1993.01420200045008. View

Menendez M, Neuhaus V, van Dijk C, Ring D . The Elixhauser comorbidity method outperforms the Charlson index in predicting inpatient death after orthopaedic surgery. Clin Orthop Relat Res. 2014; 472(9):2878-86. PMC: 4117875. DOI: 10.1007/s11999-014-3686-7. View

10.

Hong J, Murphy J, Wang S, Koong A, Chang D . Chemoradiotherapy before and after surgery for locally advanced esophageal cancer: a SEER-Medicare analysis. Ann Surg Oncol. 2013; 20(12):3999-4007. DOI: 10.1245/s10434-013-3072-9. View

11.

Jarnagin W, Ruo L, Little S, Klimstra D, DAngelica M, DeMatteo R . Patterns of initial disease recurrence after resection of gallbladder carcinoma and hilar cholangiocarcinoma: implications for adjuvant therapeutic strategies. Cancer. 2003; 98(8):1689-700. DOI: 10.1002/cncr.11699. View

12.

Southern D, Quan H, Ghali W . Comparison of the Elixhauser and Charlson/Deyo methods of comorbidity measurement in administrative data. Med Care. 2004; 42(4):355-60. DOI: 10.1097/01.mlr.0000118861.56848.ee. View

13.

McNamara M, Walter T, Horgan A, Amir E, Cleary S, McKeever E . Outcome of adjuvant therapy in biliary tract cancers. Am J Clin Oncol. 2014; 38(4):382-7. DOI: 10.1097/COC.0b013e31829e19fb. View

14.

Averitt A, Weng C, Ryan P, Perotte A . Translating evidence into practice: eligibility criteria fail to eliminate clinically significant differences between real-world and study populations. NPJ Digit Med. 2020; 3:67. PMC: 7214444. DOI: 10.1038/s41746-020-0277-8. View

15.

Tariq N, McNamara M, Valle J . Biliary tract cancers: current knowledge, clinical candidates and future challenges. Cancer Manag Res. 2019; 11:2623-2642. PMC: 6446989. DOI: 10.2147/CMAR.S157092. View

16.

Blaga M, Brasoveanu V, Stroescu C, Ionescu M, Popescu I, Dumitrascu T . Pattern of the First Recurrence Has No Impact on Long-Term Survival after Curative Intent Surgery for Perihilar Cholangiocarcinomas. Gastroenterol Res Pract. 2018; 2018:2546257. PMC: 6109483. DOI: 10.1155/2018/2546257. View

17.

Pinter M, Hucke F, Zielonke N, Waldhor T, Trauner M, Peck-Radosavljevic M . Incidence and mortality trends for biliary tract cancers in Austria. Liver Int. 2013; 34(7):1102-8. DOI: 10.1111/liv.12325. View

18.

Bergquist J, Shah H, Habermann E, Hernandez M, Ivanics T, Kendrick M . Adjuvant systemic therapy after resection of node positive gallbladder cancer: Time for a well-designed trial? (Results of a US-national retrospective cohort study). Int J Surg. 2018; 52:171-179. DOI: 10.1016/j.ijsu.2018.02.052. View

19.

Crino L, Scagliotti G, Marangolo M, Figoli F, Clerici M, de Marinis F . Cisplatin-gemcitabine combination in advanced non-small-cell lung cancer: a phase II study. J Clin Oncol. 1997; 15(1):297-303. DOI: 10.1200/JCO.1997.15.1.297. View

20.

Wang S, Lemieux A, Kalpathy-Cramer J, Ord C, Walker G, Fuller C . Nomogram for predicting the benefit of adjuvant chemoradiotherapy for resected gallbladder cancer. J Clin Oncol. 2011; 29(35):4627-32. PMC: 3236647. DOI: 10.1200/JCO.2010.33.8020. View