Exclusive liver/serosa invasion as a better prognostic indicator in T3 gallbladder cancer.

Abstract

T3 gallbladder cancer includes diverse invasive tumors. However, distinct prognostic outcomes may be observed among T3 gallbladder cancer confined to a localized range despite sharing the same classification. We analyzed patients with T3 gallbladder cancer who underwent surgery from 2002 to 2021. They were divided into 4 groups on the basis of the invasion site: liver, serosa, extrahepatic bile duct, and adjacent organs. We compared their clinicopathologic, perioperative, and prognostic data. We identified 216 patients with T3 gallbladder cancer. The median survival times for patients with tumors invading only the serosa (n = 54), liver (n = 94), bile duct (n = 50), and adjacent organs (n = 18) were 25.8, 26.6, 18.7, and 12.4 months, respectively. Patients with liver and serosa invasion showed comparable oncologic outcomes (P = .44), similar to those with bile duct and adjacent organ invasion (P = .41). The combined liver/serosa invasion group had better median survival than the bile duct/organ invasion group (26.6 months vs 17.3 months, P < .001). Combined bile duct/organ invasion was associated with more frequent nodal metastasis (71.2% vs 53.8%, P < .001), a greater proportion of N2 (33.3% vs 8.5%, P < .001), and more frequent R1 resection (21.9% vs 4.8%, P < .001). In addition, bile duct/organ invasion was an independent prognostic factor for poorer survival (hazard ratio, 1.6; 95% confidence interval, 1.13-2.67, P = .008), as was nodal metastasis (hazard ratio, 1.55; 95% confidence interval, 1.08-2.24, P = .018). Gallbladder cancers confined to the liver and serosa exhibited a more favorable prognosis, highlighting needed subclassification within T3 gallbladder cancer.