Analysis Of Prognostic Factors And Adjuvant Therapy Strategy In Patients With Gallbladder Carcinoma Undergoing Surgery

Objective: The purposes of this study is to explore the risk factors affecting the survival and prognosis of patients with gallbladder carcinoma undergoing radical surgery,and evaluate surgery conbined different adjuvant treatment strategies of cancer-specific survival prognosis in gallbladder carcinoma(GBC)patients using SEER(Surveillance,Epidemiology,and End Results Program)database.And try to gain the best ajuvant therapy stratege.So as to provide a theoretical basis for determine the prognosis of patients undergoing surgery,but also offer a reference for the choice of clinical treatment strategies.Methods: We collected the clinical data of patients diagnosed as gallbladder carcinoma from 1998 to 2013 from the National Cancer Institute Surveillance,Epidemiology and results Database(Surveillance,Epidemiology,and End Results Program,SEER).After inclusion and exclusion way,the basic information and other clinical data were collected.To analyze the risk factors that may affecting the prognosis of patients after surgical resection.Then the patients were divided into four groups according to different therapy strategie(single operation group,surgery and radiotherapy group,surgery and chemotherapy group,surgery and chemoradiotherapy group).In order to eliminate the selection bias of intergroup confounding factors,we use the propensity score matching(Propensity Score Matching)PSM for variables.We take the descriptive statistical analysis to show the baseline characteristics with and Pearson Chi-square test was used to calculate the differences among groups.We use the univariate and multivariate Cox proportional regression models to evaluate the correlation prognosis factors between clinical variables for OS and CSS.The matched data we analyzed by Kaplan-Meier curve and Cox regression to analysis of CSS between groups.Then the different subgroups were chosed according to age,different degrees of differentiation,different AJCC T and N stage.To further explore whether the relevant adjuvant therapy strategies have statistical significance on the prognosis of CSS with different subgroups patients.Results: 1.A total of 1247 patients with GBC were included in this study.Including surgery+adjuvant radiotherapy 48 cases(3.8%),surgery+adjuvant chemotherapy 216cases(17.4%),surgery+adjuvant chemoradiotherapy group 285cases(22.9%)and alone surgery group 698cases(55.9%).2.Univariate Cox proportional regression model analysis showed that age,years of diagnosis,degree of tumor differentiation,adjuvant therapy,AJCC T stage and N stage as important factors affecting 5-year OS in patients with GBC.Multivariate Cox proportional regression model analysis showed that age,years of diagnosis,degree of tumor differentiation,adjuvant therapy,AJCC T stage and N stage as independent risk factors affecting 5-year OS in patients with GBC.Univariate Cox proportional regression model analysis showed that age,years of diagnosis,degree of tumor differentiation,adjuvant therapy,AJCC T stage and N stage and AJCC stage as important risk factors for 5-year CSS.Multivariate analysis showed that age,years of diagnosis,degree of tumor differentiation,adjuvant therapyst strategy,N stage and AJCC stage as independent risk factors were independent risk factors affecting the prognosis for 5-year CSS.3.Kaplan-Meier survival curve analysis showed that the surgery+adjuvant chemoradiotherapy has the most well prognostic after PSM,the CSS rate of patients in surgery+adjuvant chemoradiotherapy group and alone surgery group were 1-year CSS rate(79.1%vs.43.8%),3-year CSS rate(39.5%vs.12.2%),5-year CSS rate(30.1% vs.5.6%),respectively,and the median survival time(months)was 11 months and 23 months.Cox proportional regression model analysis showed that the risk ratio of factors in CSS was surgery+adjuvant radiotherapy group is HR(0.518,95%CI[0.332-0.808],p=0.003),surgery+adjuvant chemodiotherapy HR(0.584,95%CI[0.477-0.715],p<0.001),surgery+adjuvant chemoradiotherapy HR(0.398,95%CI[0.328-0.480],p<0.001).As stratification of age,years of diagnosis,degree of tumor differentiation,adjuvant therapy,AJCC T stage and N stage aftert PSM,it was found that patients of different subgroup were sensitive to surgery+adjuvant chemoradiotherapy.The 5year CSS rate of patients with younger and older,poorly/undifferentiated or well/moderately differentiatedwere carcinoma,different T stage subgroup and N stage subgroups have significantly increased after surgery+adjuvant chemoradiotherapy,and the 5year survival rate of patients increased in stratified analysis of every subgroups(p<0.05).Howerver,the surgery+chemotherapy for T4 stage was not significantly associated with CSS.Conclusion:In a conclusion,age,years of diagnosis,degree of tumor differentiation,adjuvant therapy,AJCC T stage and N stage are independent risk factors affecting the OS prognosis of GBC,age,years of diagnosis,degree of tumor differentiation,adjuvant therapy,N stage and AJCC stage are independent risk factors affecting the prognosis of CSS.Surgery+adjuvant radiotherapy,adjuvant chemotherapy,adjuvant chemoradiotherapy all can improve the prognosis with GBC of CSS,and the surgery+adjuvant chemoradiotherapy stratege has the most degree of survival benifit.