166P - Preoperative risk factors strongly related to early recurrence after R0 resection of gallbladder cancer

Background

Gallbladder (GB) cancer shows high prevalence in South Korea, and tends to show high fatality. In surgically fit patients, radical resection aiming an R0 margin combined with lymphadenectomy is the mainstay of curative-intent therapy. In spite of R0 resection, however, high recurrence rate is observed in GB cancer, demanding a need to figure out risk factors related to recurrence after surgery.

Methods

This is a single center, retrospective cohort study conducted on 148 patients with GB cancer who underwent R0 resection between January 1st, 2014 and December 31st, 2019. Several variables were analyzed with statistical tools to identify risk factors related to prognosis. Early recurrence, defined as progression of disease within one year after R0 resection, was studied with logistic regression analysis.

Results

Early recurrence was observed in 15.5% (N=23) of patients. Based on statistical analysis, independent risk factors of early recurrence were age over 65 (hazard ratio [HR] 4.44, 95% confidence interval [CI] 1.25 - 15.75, p=0.021), glycated hemoglobin (HbA1c) level more than 6.5% (HR 5.00, 95% CI 1.37 – 18.31, p=0.015), surgical T stage more than T3 (HR 16.76, 95% CI 5.76 – 48.73, p<0.001), surgical N stage more than N1 (HR 5.82, 95% CI 2.22 – 15.28, p<0.001), pathologic differentiation of moderate to poor differentiation (HR 5.20, 95% CI 1.64 – 16.48, p=0.005), reversed albumin-globulin ratio (HR 0.08, 95% CI 0.01 – 0.45, p=0.004), high c-reactive protein (CRP) level (HR 1.22, 95% CI 1.08 – 1.38, p=0.001), and high carbohydrate antigen (CA) 19-9 level (HR 3.53, 95% CI 1.36 – 9.13, p=0.009). Table: 166P

Conclusions

Advanced pathologic stage and high inflammatory marker levels, reflecting high tumor burden, were related with poor surgical outcome. Interestingly, high HbA1c level was connected with early recurrence as well. In conclusion, active screening for early detection, reducing inflammatory conditions, and managing diabetes might reduce early recurrence after R0 resection of GB cancer.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Pusan National University Hospital.

Funding

This work was supported by clinical research grant from Pusan National University in 2023.

Disclosure

All authors have declared no conflicts of interest.