Abstract 59P
Background
Because of the high mortality and rarity of GBC, the best adjuvant modality of radically resected GBC is not well established.
Methods
We audited the records of radically resected GBC who received adjuvant therapy over a decade (2007-2017) to gain an insight on the efficacy of various modalities of treatment. In the period 2007-2012 only concurrent chemo-radiation (CTRT, n=40) was practised. Since 2013, very low risk patients were kept on observation (R0, T2, T3, N0), low risk patients (R0, T2, T3 and N0, N1) received CT and high risk patients (R1, N2, T3, T4, LVI, PNI) received CTRT. The lack of concrete guidelines for adjuvant therapy according to risk and treatment offered according to physician discretion resulted in overlap in risk criteria in the three groups. Univariate and multivariate analysis was done to ascertain the effect of different treatment modalities on prognostic factors using spss (v.20).
Results
The median age of patients (n=142) was 50 years. At a median follow-up of 50 months, the median OS of all patients was 34 months.The median OS was NR vs 46 mo vs 30 mo with CT, CTRT and observation respectively (p=0.24). Young aged women had better OS with CTRT. On univariate analysis, the median OS of patients less than 50 was 48 months (p=0.29), females had better OS (50 mo vs 26 mo, p=0.07), those with co-morbidity were worse (26 mo vs 48 mo, p=0.29). T2 patients had the best OS [72 mo vs 40 mo (T3) vs 16 mo (T4), p = 0.13], node negative had better OS (72 months vs 40 mo, (p=0.08)). The effect of various adjuvant modalities on OS based on the prognostic factors is given in the table below. On multivariate analysis the hazard ratio of various prognostic factors influencing OS were resection status (HR 2.49, p=0.00), male (HR 1.3, p=0.25), T status (HR 2.1, p=0.15) and nodal status (HR 1.3, p=0.2) Table: 59P
| Observation | CT | CTRT | |
| Age group <50 (73) >50 (64) | 30 26 | 48 NR | 108 (p=0.44) 34 |
| Male (35) Female (107) | 6 32 | NR 50 | 27 (p=0.07) 72 |
| T2 (79) T3 (58) T4 (5) | 25 50 - | NR 39 20 | 34 (0.13)4616 |
| Node negative (65) Node positive (77) | 32 18 | NR48 | 51 (p=0.08)34 |
| R0 (107)R1 (35) | 32 - | NR - | NR (p=0.00) 23 |
Conclusions
CT should be the standard of care as adjuvant therapy for all GBC patients. CTRT should be used in high risk features like R1, LVI and PNI.
Clinical trial identification
Editorial acknowledgement
Legal entity responsible for the study
Sushma Agrawal.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.