Prognostic Impact of Neoadjuvant Chemotherapy in Gallbladder Cancer: a Population- Based and Propensity Score Matched SEER Analysis

Background: The effect of neoadjuvant chemotherapy (NACT) in gallbladder cancer (GBC) patients remains controversial. The aim of this study was to assess the impact of NACT on overall survival (OS), cancer specific survival (CSS), and to explore possible protective predictors for prognosis. Methods: : GBC patients’ data were collected from the Surveillance, Epidemiology, and End Results (SEER) database. Patients in the NACT and non-NACT groups were propensity score matched (PSM) 1:3, the Kaplan-Meier method and log-rank test were performed to analyze the impact of NACT on OS and CSS. Univariable and multivariable Cox regression models were applied to identify the possible prognostic factors. Results: : Of the 5,003 cases diagnosed as stage I-III GBC according to AJCC 8 th TNM stage, 64 NACT and 192 non-NACT patients remained after PSM. In all GBC patients, the median OS of the NACT and non-NACT was 31 and 20 months (log-rank P ＜0.001), and the median CSS of NACT and non-NACT was 31 and 24 months (log-rank P =0.002). While in advanced GBC patients, the median OS of the NACT and non-NACT groups were 27 and 16 months (log-rank P ＜0.001), respectively, and the median CSS of the NACT and non-NACT groups were 27 and 19 months (log-rank P =0.006), respectively. Multivariable Cox regression analysis showed that NACT, lymph node dissection (LND) and surgery type were positive protective factors for OS and CSS in GBC patients. Conclusions: : Patients receiving NACT had significantly better survival than those that did not. NACT may provide therapeutic benefits for GBC patients, especially for those at an advanced stage. NACT combined with radical surgery improved the survival time of GBC patients. Therefore, NACT combined with surgery may provide a better treatment option for advanced GBC patients.