Trends in Treatment and Survival of Gallbladder Cancer in the Netherlands; Identifying Gaps and Opportunities from a Nation-Wide Cohort
Abstract
:1. Background
2. Methods
2.1. Patient Selection and Variable Definitions
2.2. Quality Control and Completeness of Data Assessment
2.3. Statistical Analysis
3. Results
3.1. Incidence and Patient and Tumor Characteristics
3.2. Treatment
3.3. Survival
3.4. Therapy and Survival
3.5. Prognostic Factors for Survival
3.6. Quality Control
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Appendix A
ICD-03 code | Frequency (%) | |
8000 | Neoplasma | 310 (16.6) |
8001 | Tumor cells | 2 (0.1) |
8010 | Carcinoma, NOS | 50 (2.7) |
8012 | Large cell carcinoma NOS | 35 (1.9) |
8013 | Large cell neuroendocrine carcinoma | 6 (0.3) |
8020 | Carcinoma, undifferentiated, NOS | 5 (0.3) |
8030 | Giant cell and spindle cell carcinoma | 2 (0.1) |
8032 | Spindle cell carcinoma, NOS | 2 (0.1) |
8033 | Pseudosarcomatous carcinoma | 3 (0.2) |
8041 | Small cell carcinoma, NOS | 10 (0.5) |
8046 | Non-small cell carcinoma | 4 (0.2) |
8070 | Squamous cell carcinoma, NOS | 19 (1.0) |
8071 | Squamous cell carcinoma, keratinizing, NOS | 2 (0.1) |
8074 | Squamous cell carcinoma, spindle cell | 1 (0.1) |
8140 | Adenocarcinoma, NOS | 1171 (62.6) |
8144 | Adenocarcinoma, intestinal type | 21 (1.1) |
8160 | Cholangiocarcinoma | 6 (0.3) |
8163 | Pancreatobiliary-type carcinoma | 5 (0.3) |
8210 | Adenocarcinoma in adenomatous polyp | 7 (0.4) |
8211 | Tubular adenocarcinoma | 2 (0.1) |
8240 | Carcinoid tumor, NOS | 13 (0.7) |
8244 | Mixed adenoneuroendocrine carcinoma | 2 (0.1) |
8246 | Neuroendocrine carcinoma, NOS | 6 (0.3) |
8249 | Atypical carcinoid tumor | 2 (0.1) |
8260 | Papillary adenocarcinoma, NOS | 36 (1.9) |
8263 | Adenocarcinoma in tubolovillous adenoma | 3 (0.2) |
8310 | Clear cell adenocarcinoma, NOS | 3 (0.2) |
8312 | Renal cell carcinoma, NOS | 1 (0.1) |
8350 | Nonencapsulated sclerosing carcinoma | 1 (0.1) |
8480 | Mucinous adenocarcinoma | 31 (1.7) |
8481 | Mucin-producing adenocarcinoma | 44 (2.4) |
8490 | Signet ring cell carcinoma | 19 (1.0) |
8500 | Infiltrating duct carcinoma, NOS | 2 (0.1) |
8503 | Intraductal papillary adenocarcinoma with invasion | 4 (0.2) |
8560 | Adenosquamous carcinoma | 26 (1.4) |
8570 | Adenocarcinoma with squamous metaplasia | 1 (0.1) |
8574 | Adenocarcinoma with neuroendocrine differentiation | 10 (0.5) |
8575 | Metaplastic carcinoma, NOS | 1 (0.1) |
8576 | Hepatoid adenocarcinoma | 1 (0.1) |
8980 | Carcinosarcoma, NOS | 3 (0.2) |
Appendix B. Incidence of Gallbladder Cancer Per 100.000 Inhabitants in the Netherlands, 2005–2016
Appendix C. Survival of Gallbladder Cancer Patients by Disease Stage and Period of Diagnosis
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Cohort | Total (n = 1834) | Resected (n = 661) | Non-resected Non-metastatic (n = 278) | Metastatic (n = 895) |
---|---|---|---|---|
Patient and tumor characteristics | ||||
Age | 71.1 (22–97) | 69.2 (27–97) | 74.3 (32–95) | 71.2 (22–96) |
Male sex | 545 (29.1%) | 206 (31.2%) | 82 (29.5%) | 250 (27.9%) |
Socioeconomic Status | ||||
High | 501 (26.8%) | 183 (27.7%) | 82 (29.5%) | 229 (33.4%) |
Medium | 741 (39.6%) | 253 (38.3%) | 110 (39.6%) | 367 (41.0%) |
Low | 630 (33.7%) | 225 (34.0%) | 86 (30.9%) | 299 (33.4%) |
Clinicopathologic T stage a | ||||
T1 | 526 (28.1%) | 147 (22.6%) | 1 (0.4%) | 54 (8.5%) |
T2 | 303 (45.8%) | 0 (0.0%) | 22 (2.5%) | |
T3/T4 | 643 (34.3%) | 172 (26.2%) | 169 (60.8%) | 427 (47.7%) |
TX | 496 (26.5%) | 38 (5.8%) | 13 (4.7%) | 302 (33.7%) |
Unknown/missing | 207 (11.1%) | - | 95 (34.2%) | 90 (10.1%) |
Clinicopathologic N stage a | ||||
N0 | 674 (36.0%) | 140 (21.2%) | 62 (22.3%) | 237 (26.5%) |
N1 | 432 (23.1%) | 123 (18.6%) | 74 (26.6%) | 331 (37.0%) |
NX | 559 (29.9%) | 387 (58.5%) | 47 (16.9%) | 237 (26.5%) |
Unknown/missing | 207 (11.1%) | 11 (1.7%) | 95 (34.2%) | 90 (10.1%) |
Location synchronous metastases | ||||
Liver | N/A | N/A | N/A | 350 (39.1%) |
Peritoneal | N/A | N/A | N/A | 119 (13.3%) |
Lymph node | N/A | N/A | N/A | 46 (5.1%) |
Lung | N/A | N/A | N/A | 11 (1.2%) |
Liver + peritoneum | N/A | N/A | N/A | 92 (10.3%) |
Other | N/A | N/A | N/A | 22 (2.5%) |
Multiple, other | N/A | N/A | N/A | 175 (19.6%) |
Unknown/missing | N/A | N/A | N/A | 80 (8.9%) |
Pathology confirmation of primary tumor(yes) | 1566 (83.7%) | 661 (100%) | 156 (56.1%) | 732 (81.8%) |
Differentiation grade | ||||
Well | N/A | 102 (15.4%) | N/A | N/A |
Moderate | N/A | 209 (31.6%) | N/A | N/A |
Poor | N/A | 157 (23.7%) | N/A | N/A |
Not determined | N/A | 193 (29.2%) | N/A | N/A |
Radicality | ||||
R0 | N/A | 417 (63.1%) | N/A | N/A |
R1 | N/A | 130 (19.7%) | N/A | N/A |
R2 | N/A | 24 (3.6%) | N/A | N/A |
Unclear | N/A | 90 (13.6%) | N/A | N/A |
Group | N | Five-year Survival | Median OS, Months (95% CI) | Log Rank Test p Value |
---|---|---|---|---|
Total | 1895 | 13.2% | 5.5 (5.0–6.0) | |
Resected non-metastatic | 661 | 34.2% | 23.7 (19.6–27.8) | |
Adjuvant chemotherapy | 12 | 37.5% | 29.4 (21.4–37.5) | 0.521 |
No adjuvant chemotherapy | 649 | 34.1% | 23.7 (19.4–27.6) | |
T1b/T2 tumor, no radical surgery | 106 | 30.6% | 18.3 (13.8–22.7) | <0.001 |
T1b/T2 tumor, radical surgery | 274 | 52.7% | 76.7 (43.0–110.3) | |
Non-resected non-metastatic | 278 | 2.9% | 3.6 (3.1–4.1) | |
No palliative chemotherapy | 257 | 3.0% | 3.5 (2.9–4.0) | 0.011 |
Palliative chemotherapy | 21 | - | 7.7 (4.5–10.8 | |
Metastatic | 895 | 1.3% | 2.9 (2.6–3.2) | |
No palliative chemotherapy | 690 | 0.6% | 2.1 (1.9–2.4) | <0.001 |
Palliative chemotherapy | 205 | 3.7% | 7.3 (6.4–8.2) |
A. Prognostic factors for patients with resected gallbladder cancer. N = 661. | ||||||
Characteristic | Univariable Cox Regression | Multivariable Cox Regression | ||||
HR | 95% CI | p Value | HR | 95% CI | p Value | |
Grade | ||||||
Well | 1 | 1 | ||||
Moderate | 1.41 | 1.02–1.95 | 0.036 | 1.17 | 0.84–1.61 | 0.354 |
Poor | 2.67 | 1.93–3.70 | <0.001 | 2.07 | 1.49–2.86 | <0.001 |
Unknown | 1.45 | 1.05–1.99 | 0.023 | 1.74 | 1.26–2.41 | 0.001 |
Sex | ||||||
Female | 1 | |||||
Male | 0.88 | 0.71–1.08 | 0.214 | |||
Pathological T stage | ||||||
T1 | 1 | 1 | ||||
T2 | 1.77 | 1.35–2.32 | <0.001 | 1.58 | 1.19–2.10 | 0.001 |
T3/T4 | 3.59 | 2.69–4.78 | <0.001 | 2.61 | 1.89–3.61 | <0.001 |
Tx | 3.23 | 2.01–5.18 | <0.001 | 2.16 | 1.34–3.50 | 0.002 |
Pathological N stage | ||||||
N0 | 1 | 1 | ||||
N1 | 2.96 | 2.13–4.12 | <0.001 | 1.95 | 1.39–2.74 | <0.001 |
Nx | 2.48 | 1.86–3.31 | <0.001 | 1.86 | 1.46–2.66 | <0.001 |
Radicality | ||||||
R0 | 1 | 1 | ||||
R1/R2 | 3.78 | 3.03–4.71 | <0.001 | 2.69 | 2.11–3.43 | <0.001 |
Unclear | 1.60 | 1.20–2.14 | 0.001 | 1.48 | 1.10–1.98 | 0.009 |
Adjuvant chemotherapy (yes) | 0.67 | 0.33–1.36 | 0.268 | |||
Prior malignancy (yes) | 1.22 | 0.93–1.61 | 0.150 | |||
Increasing age (years) | 1.04 | 1.03–1.05 | <0.001 | 1.04 | 1.03–1.05 | <0.001 |
B. Prognostic factors for patients with metastatic gallbladder cancer. N = 895. | ||||||
Characteristic | Univariable Cox Regression | Multivariable Cox Regression | ||||
HR | 95% CI | p Value | HR | 95% CI | p Value | |
Grade | ||||||
Well | 1 | |||||
Moderately | 1.02 | 0.61–1.71 | 0.931 | |||
Poor | 1.45 | 0.89–2.36 | 0.136 | |||
Unknown | 1.85 | 1.16–2.97 | 0.010 | |||
Sex | ||||||
Female | 1 | |||||
Male | 0.88 | 0.71–1.08 | 0.214 | |||
Clinical T stage | ||||||
T1/T2 | 1 | 1 | ||||
T3/T4 | 2.01 | 1.57–2.58 | <0.001 | 1.33 | 1.02–1.73 | 0.036 |
Tx | 1.82 | 1.41–2.35 | <0.001 | 1.33 | 1.02–1.74 | 0.035 |
Unknown | 3.94 | 2.88–5.39 | <0.001 | 2.22 | 1.57–3.15 | <0.001 |
Clinical N stage | ||||||
N0 | 1 | 1 | ||||
N1 | 1.28 | 1.07–1.50 | 0.006 | 1.21 | 1.02–1.44 | 0.031 |
Nx | 1.50 | 1.25–1.80 | <0.001 | 1.54 | 1.28–1.86 | <0.001 |
Unknown | 2.70 | 2.11–3.47 | <0.001 | ** | ||
Supportive therapy (yes) | 1.07 | 0.90–1.27 | 0.443 | |||
Palliative chemotherapy (yes) | 0.46 | 0.39–0.54 | <0.001 | 0.47 | 0.39–0.55 | <0.001 |
Prior malignancy (yes) | 0.93 | 0.80–1.08 | 0.358 | |||
Increasing age (year) | 1.03 | 1.03–1.04 | <0.001 | 1.02 | 1.01–1.03 | <0.001 |
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de Savornin Lohman, E.; de Bitter, T.; Verhoeven, R.; van der Geest, L.; Hagendoorn, J.; Haj Mohammad, N.; Daams, F.; Klümpen, H.-J.; van Gulik, T.; Erdmann, J.; et al. Trends in Treatment and Survival of Gallbladder Cancer in the Netherlands; Identifying Gaps and Opportunities from a Nation-Wide Cohort. Cancers 2020, 12, 918. https://doi.org/10.3390/cancers12040918
de Savornin Lohman E, de Bitter T, Verhoeven R, van der Geest L, Hagendoorn J, Haj Mohammad N, Daams F, Klümpen H-J, van Gulik T, Erdmann J, et al. Trends in Treatment and Survival of Gallbladder Cancer in the Netherlands; Identifying Gaps and Opportunities from a Nation-Wide Cohort. Cancers. 2020; 12(4):918. https://doi.org/10.3390/cancers12040918
Chicago/Turabian Stylede Savornin Lohman, Elise, Tessa de Bitter, Rob Verhoeven, Lydia van der Geest, Jeroen Hagendoorn, Nadia Haj Mohammad, Freek Daams, Heinz-Josef Klümpen, Thomas van Gulik, Joris Erdmann, and et al. 2020. "Trends in Treatment and Survival of Gallbladder Cancer in the Netherlands; Identifying Gaps and Opportunities from a Nation-Wide Cohort" Cancers 12, no. 4: 918. https://doi.org/10.3390/cancers12040918