Impact of Primary Tumor Resection on Survival of Patients with Metastatic Gallbladder Carcinoma: A Population-Based, Propensity Matched Study

BACKGROUND: Gallbladder carcinoma (GBC) is relatively rare but highly aggressive and it has poor prognosis, especially for metastatic GBC. We aimed to determine the prognostic significance of primary tumor resection on patients with metastatic GBC. MATERIAL/METHODS: The records of patients with GBC with distant metastasis from 2010 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Kaplan-Meier methods were used to compare overall survival (OS) and carcinoma-specific survival (CSS) between patients receiving primary tumor resection and those without surgery. Cox regression analysis was conducted to identity independent factors significantly associated with survival. In addition, a propensity score-matched analysis was performed to adjust for the heterogeneity between the groups. RESULTS: Of the 1337 patients included, 496 patients underwent primary tumor resection and 841 patients did not. Multivariate Cox regression analysis showed that OS (hazard ratio [HR]: 0.56, 95% confidence interval [CI]: 0.48–0.66, P<0.001) and CSS (HR: 0.57, 95% CI: 0.48–0.66, P<0.001) were significantly improved in patients receiving surgical resection of the primary tumor lesion in the unmatched cohort. Additionally, in the matched cohort, univariate Cox regression analysis similarly indicated that performing surgery at the primary site was associated with better OS (HR: 0.62, 95% CI: 0.50–0.77, P<0.001) and CSS (HR: 0.61, 95% CI: 0.50–0.762, P<0.001). CONCLUSIONS: This study indicated that primary tumor resection might prolong survival in patients with metastatic GBC.