Incidence and prognosis of biliary tract and gallbladder cancers in an academic hospital

Introduction

Biliary tract and gallbladder cancers are rare tumors with a poor prognosis (except ampulla). There is a variation in the evolution of the incidence around the world. According to Belgian Cancer Registry, the number of hepatobiliary cancers increases every year since 2004.

Material and Methodology

A retrospective study was performed. Patients with cholangiocarcinoma, ampulla or gallbladder cancers who were diagnosed at CHU UCL Namur site Godinne between 1997 and 2017 were included in this analysis. The evolution of the incidence was evaluated by the Mann-Kendall method on 7 periods of 3 years. We calculated the survival of these patients by the Kaplan Meier method and we determined prognostic factors by the logrank test.

Results

Between 1997 and 2017, we report an incidence of 128 patients in our center. Twenty percent were ampulla, 77% cholangiocarcinoma including 38% intrahepatic, 16% hilar and 23% extrahepatic. Last 3% corresponded to gallbladder cancer. According to the Mann-Kendall test, the evolution of the incidence of these cancers increases significantly with a slope of Sen of 7 corresponding to 7 additional new cases for each successive 3-year period (p=0.003). Our population consisted of 52% males with an average age of 68.6±11.9 years. Forty-five percent smoked, 14% consumed more than 3 units of alcohol a day, 8% had cirrhosis and 20% were diabetic. Regarding treatments, 34% had surgery, 59% received chemotherapy and 26% only supportive care. The average BMI was 26.4±5.6kg/m². The one-year overall survival was 52.0±4.7%. Poor prognosis factors were age and metastatic disease (p<0.001). The ampulla had a better prognosis with a one-year overall survival of 75.1%±9.8% compared to cholangiocarcinoma intrahepatic, hilar and extrahepatic with respectively 38.0±7.4%, 38.6±12.5% and 51.9±9.6% (p<0.001 for all). Finally, intrahepatic cholangiocarcinoma had a lower progression-free survival than the extrahepatic cholangiocarcinoma with a hazard ratio of 2.33 (p=0.001), however survival was identical.

Conclusion

Incidence of biliary tract and gallbladder cancers increases in our center. Further investigations are needed to determine the reasons for this increase. Although new therapies are emerging, these cancers still have a poor prognosis. Determining risk factors could help to develop preventive approach.