Geographic Variation in T2 Gallbladder Carcinoma Survival: Data on 316 Patients Pubblico

Abstract

Background: The reported prognosis of gallbladder carcinoma (GBC) varies widely worldwide due, at least in part, to the differences in staging. To assess differences in prognosis independent of disease stage, this study examines survival in a geographically diverse sample of cases with pathologically confirmed T2 GBC, defined as primary tumor that invades into perimuscular connective tissue without extension beyond serosa or into liver. Methods: Data onpatient demographic characteristics and survival were obtained from 316 cases of histologically proven T2 GBC from collaborating institutions in three countries and were microscopically verified: Chile (n=137), South Korea (n=105), and the USA (n=74). Overall and disease-specific survival estimates were compared across the three sites using multivariable Cox proportional hazard models, which controlled for patient age and sex. Results: Compared to patients from South Korea, patients from Chile had a significantly worse prognosis with respect to overall and, in particular, disease-specific survival. The corresponding differences between South Korea and the USA were also pronounced and statistically significant. Patient sex and age were not associated with prognosis in either analysis. Conclusions: There are notable geographic differences in GBC survival even after limiting the comparisons to patients with confirmed T2 stage. Thus, an important next step is to compare clinical practices in different countries.

Table of Contents

SECTION (Page Number)

ACKNOWLEDGMENTS (vi)

TABLE OF CONTENTS (vii)

CHAPTER 1: INTRODUCTION (1)

Background (1)

Statement of the Problem (2)

Purpose of the Study (2)

Research Questions (3)

Significance Statement (3)

Research Design (3)

CHAPTER 2: REVIEW OF THE LITERATURE (4)

Carcinoma of the Gallbladder (4)

Gallbladder Cancer Worldwide (5)

Pathology and Staging of Gallbladder Cancer (6)

Management of Gallbladder Cancer (8)

Gallbladder Cancer Prognosis (13)

Conclusion (17)

CHAPTER 3: MANUSCRIPT (19)

Abstract (20)

Introduction (21)

Methods (22)

Results (24)

Discussion (25)

References (29)

Tables and Figures (32)

CHAPTER 4: CONCLUSION AND RECOMMENDATIONS (37)

Major Findings (37)

Conclusion (37)

Recommendations (38)

REFERENCES (39)

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	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Pathology Health Sciences, Oncology
Parola chiave	survival tumor staging gallbladder carcinoma
Committee Chair / Thesis Advisor	Goodman, Michael, Emory University
Committee Members	Adsay, Volkan, Emory University Ali, Mohammed K, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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