"IN-SITU" CARCINOMA OF THE GALLBLADDER: A SEER PERSPECTIVE Open Access

Patel, Kajal Nilesh (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/6395w7395?locale=en
Published

Abstract

ABSTRACT

"IN-SITU" CARCINOMA OF THE GALLBLADDER: A SEER PERSPECTIVE

By KAJAL NILESH PATEL

Background: The etiology of gallbladder cancer remains unknown, treatment options are limited and prognosis dismal. Diagnosis of gallbladder carcinomas (GBCs) is often made incidentally and at later stages. While non-papillary (flat) carcinomas represent the most common histologic group (>75%) of this neoplasm, papillary (tumoral) variants have been recognized as a distinct morphologic variant. The distinct biologic behavior of the papillary GBC is thought to confer survival benefits.

Purpose: To conduct an analysis of GBC incidence, risk factors and survival with a primary focus histology and on the earliest (in-situ) stage.

Design: Retrospective analysis of primary GBC cases identified in the Surveillance Epidemiology and End Results (SEER) program from 1973-2010.

Methods: We examined cancer trends using Joinpoint regression. Kaplan-Meier and Cox proportional hazards regression methods were used to estimate clinical and demographic survival differences.

Results: Women, non-Hispanic whites and individuals 60 years of age or older represented >50% of cases. GBC in the distant stage was diagnosed roughly 9 times more than in-situ. Papillary tumors accounted for 5.6% of all GBC, but represented over 20% of in-situ cases.. Survival of all GBC cases was inversely related to age and stage, and non-papillary histology. Incidence of in-situ disease has not changed appreciably since 1973, while 5 and 10-year survival estimates for GBC at this stage were 87% and 79%, respectively.

Conclusion: We found that in situ GBC survival was lower than previously reported. The relatively low survival of in-situ disease suggests under-staging with missed invasive or more advanced carcinomas. In addition, deaths during the long-term follow-up period provide evidence of the occurrence of a field-effect/field defect phenomenon in the biliary tree. These findings indicate the need for reviewing the entire gallbladder specimen with non-invasive GBC findings to rule out more advanced disease. Relatively stable GBC in-situ rates indicate lack of earlier cancer detection mechanisms.

Table of Contents

TABLE OF CONTENTS

1. INTRODUCTION
Introduction ................................................................................................................. 1
Overview ..................................................................................................................... 1

The Gallbladder: Organ, Structure & Histology ......................................................... 1
Risk Factors for GBC .................................................................................................. 2

GBC Clinical Features & Pathology ........................................................................... 3
Molecular Pathology of GBC ..................................................................................... 3
GBC Staging & Challenges ........................................................................................ 4
Epidemiology ............................................................................................................. 6
Gallbladder Carcinoma In-situ (CIS): What's special? ............................................. 7
Trends in GBC ............................................................................................................ 7
Relevance .................................................................................................................... 8

2. MATERIALS & METHODS
Materials and Methods ................................................................................................ 9-12

3. RESULTS
Results ........................................................................................................................ 13-16

4. DISCUSSION
Discussion ................................................................................................................... 17-22
Conclusion ................................................................................................................... 22

5. REFERENCES
References .................................................................................................................. 23-33

6. TABLES & FIGURES
Table 1: Demographic Characteristics of Patients with Gallbladder Tumors by Decade
Table 2: Clinicopathologic Characteristics of Gallbladder Tumors by Decade

Table 3: The Histopathologic Characteristics of Gallbladder Tumors by Stage

Table 4: Age-Adjusted Incidence Rates & Incidence Rate Ratios of Gallbladder Tumors by Sex, Race & Stage

Figure 1 (A-D): Trends in Observed Incidence of Gallbladder Tumors

Table 5: The 5 and 10-year Survival of Patients with Gallbladder Tumors by Sex, Race, Marital status, Histology & Stage

Figure 2 (A-C): Survival Rates for all GBCIS, Overall and by Histology

Figure 3 (A-E): Kaplan-Meier (K-M) Survival Curves for GBC cases

Table 6: 10-year Survival Cox Multivariate Regression Parameters for all GBC cases
Table 7: Cause-specific Death Classification of all GBC Tumors by Stage

7. APPENDIX: TABLES & FIGURES

Table A: AJCC Staging System

Table 1: Carcinoma In-situ: Demographic Characteristics of Patients with GBC by Decade

Table 2: Localized: Demographic Characteristics of Patients with GBC by Decade

Table 3: Regional: Demographic Characteristics of Patients with GBC by Decade

Table 4: Distant: Demographic Characteristics of Patients with GBC by Decade

Table 5: Unstaged: Demographic Characteristics of Patients with GBC by Decade

Table 6: The Histopathologic Characteristics of Gallbladder Tumors for each Stage by Year of Diagnosis

Table 7: Cox Multivariate Regression Parameters for GBC In-situ cases

Figure 1 (A-F): Trends in Observed Incidence of GBC Tumors by Stage

Figure 2 (A-F): Trends in Observed Incidence of GBC Tumors by Race & Gender

Figure 3 (A-F): Trends in 5 & 10-year Relative Survival for all GBC & GBCIS tumors

Figure 4 (A-F): Trends in 5 & 10-year Relative Survival of GBC by Gender & Race/Ethnicity

Figure 5: Relative Survival GBC cases by Histologic type & Stage at Diagnosis

Figure 6 (A-F): K-M Survival Curves for patients with GBC by Demographic Characteristics.

Figure 7 (A-F): K-M Survival Curves for patients with GBCIS

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
School
Department
Degree
Submission
Language
  • English
Research field
Keyword
Committee Chair / Thesis Advisor
Partnering Agencies
Last modified

Primary PDF

Supplemental Files