Study Cites Gains in Gall Bladder Cancer Treatment
MONDAY May 18, 2009 -- Patients with gallbladder cancer are surviving longer than they used to, but the death rate is still high, new research shows.
An estimated 9,520 cases of gallbladder or bile duct cancer were diagnosed in the United States in 2008, and about 3,340 people died of the disease, according to the study in the May issue of the Archives of Surgery.
The death rate is high, in part, because at the time of diagnosis, many patients already have advanced-stage disease and are not candidates for surgery. Resection, where the diseased portions of the organ are removed surgically, is the only means of curing it.
"Gallbladder cancer is characterized by locally aggressive behavior, with early spread to regional lymph nodes and distant dissemination," the authors wrote. "In addition, it recurs rapidly even after presumed curative resection."
Still, survival times for the disease, which affects women more frequently than men, have improved since the 1960s.
Researchers from Harvard Medical School identified 402 patients with gallbladder cancer at a university-affiliated center between 1962 and 2008. Of these, 260 underwent surgical exploration at the same institution and were included in the data analysis.
Patients were diagnosed during three periods: period A (1962 to 1979), period B (1980 to 1997) and period C (1998 to 2008).
Overall median survival improved from 3.5 months during period A to six months in period B to one year in period C.
Survival times were the longest among those whose disease was caught early. The median survival was 10.3 months for those diagnosed with stage 2 cancer, compared to 4.7 months for stage 3 disease and 4 months for stage 4.
"The survival of patients who presented with advanced-stage disease and who underwent palliative [treating symptoms only] procedures remained poor in all periods," with patients surviving a median of 1.9 months in the 1960s and 70s to 3.6 months in recent years.
Of the 260 cancer patients who had surgery to explore the extent of their disease, about 58 percent had the cancer surgically removed. Unresectable disease became less common over time (44.4 percent in periods A and B and 17.3 percent in period C).
Between January 1994 and March 2008, 6,881 laparoscopic cholecystectomies (procedures to remove gallstones) were performed at the same facility. Gallbladder cancer was found in 17 patients incidentally during these procedures.
"When gallbladder cancer is found incidentally during or after a cholecystectomy, aggressive resection should be performed either during the present operation or during a second operation," the authors wrote. "In our series, 56 percent of patients who underwent re-exploration [a second surgery] were found to have residual disease. Patients underwent re-exploration at a median of 41 days, similar to other series."
The authors said early detection and an aggressive surgical approach was currently the most effective way of increasing survival times.
"A better understanding of the molecular pathways contributing to the development of gallbladder cancer is needed to develop improved adjuvant therapies to increase overall survival," they wrote.
The U.S. National Library of Medicine has more on gallbladder and bile duct cancer.
Posted: May 2009