Racial and Ethnic Differences in Clinical Characteristics and Prognosis of Gallbladder Cancer in United States: Analysis of Population Based Data Open Access

Ye, Chong (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/g732d899x?locale=en


Background: While racial/ethnic differences in gallbladder cancer (GBC) incidence are well known, few studies investigated how clinical characteristics and prognosis may differ in GBC patients of various races and ethnicities.  

Methods: The National Cancer Institute’s Surveillance, Epidemiology and End Results (SEER) Program was used to identify GBC patients diagnosed from 2000 through 2014. Multivariate logistic regression was used to estimate the association between race/ethnicity and cancer stage at diagnosis. Comparison of overall survival by race/ethnicity was done using Cox proportional hazard model.

Results: 7,857 GBC patients reported to SEER during the study period, 4,414 patients (56.2%) were non-Hispanic Whites, 891 (11.3%) were non-Hispanic Blacks, 1,797 (22.9%) were Hispanics, 755 patients (9.6%) were Asians/ Pacific Islanders. Compared to non-Hispanic White GBC patients, both Asians/ Pacific Islanders (Odds ratio [OR]= 0.83, 95% confidence interval [CI] 0.70, 0.99) and Hispanics (OR= 0.86, 95% CI 0.76, 0.98) had significantly lower likelihood of being diagnosed with more advanced (regional or distant) stage of the disease. Statistically significant difference was also found in post-diagnosis survival between non-Hispanic Black and non-Hispanic White GBC patients (HR: 1.10, 95% CI 1.01-1.19).

Conclusion: While Asian/Pacific Islander and Hispanic GBC patients were more likely to be diagnosed at an earlier disease stage, survival appears to be less influenced by race/ethnicity once disease stage is taken into consideration. 

Table of Contents


Gallbladder Anatomy and Function---------------------------------------------1

Cancer of the Gallbladder: Clinical Presentation and Prognosis--------2

Epidemiology of GBC---------------------------------------------------------------4

Racial/Ethnic Disparities in GBC Prognosis-----------------------------------6

Materials and Methods--------------------------------------------------------------8






Table 1. Demographic and disease characteristics of GBC patients by racial/ethnic group; SEER 2000-2014---21

Table 2. Age-standardized incidence ratea of GBC patients by racial/ethnic group 2000-2014 SEER databaseb--22

Table 3. Multivariable logistic regression analysis of the association between cancer stage at diagnosis and race/ethnicity of study participants--------23

Table 4. Multivariable survival analysis: Cox model results for variables that met the proportional hazards assumption-----24


Supplemental Table 1. Cox model limited to non-Hispanic Whites-----------------------------------------------25

Supplemental Table 2. Cox model limited to non-Hispanic Blacks-----------------------------------------------26

Supplemental Table 3. Cox model limited to Hispanics----------------------------------------------------------27

Supplemental Table 4. Cox model limited to Asians/ Pacific Islanders-------------------------------------------28

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