Gallbladder cancer: Incidence and survival in a high‐risk area of Chile

• Published in: International journal of cancer Vol. 127; no. 10; pp. 2446 - 2454
• Main Authors: Bertran, Enriqueta, Heise, Katy, Andia, Marcelo E., Ferreccio, Catterina
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 15.11.2010; Wiley-Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Chile - epidemiology; cholecystectomy; Educational Status; Female; gallbladder neoplasm; Gallbladder Neoplasms - epidemiology; Gallbladder Neoplasms - ethnology; Gallbladder Neoplasms - mortality; Gallbladder Neoplasms - pathology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Incidence; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Mapuche; Medical sciences; Middle Aged; Neoplasm Staging; Registries; risk factors; survival analysis; survival rate; Tumors; South America; Chile; America; Cholecystectomy; High risk; Mapuche; gallbladder neoplasm; risk factors; Digestive system; Bile duct cancer; Malignant tumor; Biliary tract disease; Epidemiology; Survival; Gallbladder cancer; Incidence; Gall bladder cancer; Cancerology; Treatment; survival analysis; Surgery; Risk factor; survival rate; Digestive diseases; Gallbladder; Cancer
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.25421

We assessed population incidence rates 1998–2002 and 5‐year survival rates of 317 primary gallbladder cancer (GBC) entered in the population‐based cancer registry in Valdivia. We analyzed GBC incidence (Poisson regression) and GBC survival (Cox regression). Cases were identified by histology (69.4%), clinical work‐up (21.8%), or death certificate only (8.8%). Main symptoms were abdominal pain (82.8%), jaundice (53.6%) nausea (42.6%), and weight loss (38.2%); at diagnosis, 64% had Stage TNM IV. In the period, 4% of histopathological studies from presumptively benign cholecystectomies presented GBC. GBC cases were mainly females (76.0%), urban residents (70.3%), Hispanic (83.7%) of low schooling <4 years (64.0%). GBC standardized incidence rate per 100,000 (SIR) were all 17.5 (95%CI: 15.5–19.4), women 24.3, and men 8.6 (p < 0.00001); Mapuche 25.0, Hispanic 16.2 (p = 0.09). The highest SIRs were in Mapuche (269.2) and Hispanic women (199.6) with <4 years of schooling. Lowest SIRs were among Hispanic men (19.8) and women (21.9) with >8 years of schooling. Low schooling, female and urban residence were independent risk factors. By December 31, 2007, 6 (1.9%) cases were living, 280 (88.3%) died from GBC, 32 (10.1%) were lost of follow‐up. Kaplan Meier Global 5‐year survival was: 10.3%, 85% at stage I and 1.9% at stage IV; median survival: 3.4 months. Independent poor prognostic factors were TNM IV, jaundice and nonincidental diagnoses. Our results suggest that women of Mapuche ancestry with low schooling (>50 years) are at the highest risk of presenting and dying from GBC and should be the target for early detection programs.