Association of surgical extent with survival in locally advanced gallbladder cancer based on propensity score matching

The treatment for locally advanced gallbladder cancer (GBC) remains controversial, particularly regarding the extent of surgery. This study aimed to evaluate the association between surgical extent and survival outcomes in patients with locally advanced GBC. Patients with locally advanced GBC were identified from the Surveillance, Epidemiology, and End Results (SEER) database. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier curves, Cox proportional hazards models, competing-risk models, and landmark analyses. Propensity score matching (PSM) was performed to minimize confounding, and subgroup analyses were conducted across key clinicopathological variables. Patients in the surgery group had better OS and CSS than those in the non-surgery group (median OS, 16.0 versus 9.0 months; median CSS, 17.0 versus 10.0 months; both P < 0.001), particularly when combined with multimodal therapy. Among surgically treated patients, 388 (19.8%) received radical resection (RR), while 1567 (80.2%) underwent simple resection (SR). RR was associated with improved OS and CSS compared with SR (median OS, 19.0 versus 15.0 months; median CSS, 21.0 versus 16.0 months; both P < 0.05). On multivariate analysis, RR remained independently associated with improved OS and CSS. The survival benefit of RR remained robust in 1- and 3-year landmark analyses. These results remained consistent after PSM and in competing-risk models. Subgroup analyses demonstrated consistent survival benefits from RR across various clinicopathological variables. These findings suggest that surgical intervention is associated with a survival advantage and that RR could be considered an important component of curative-intent treatment for selected patients with locally advanced GBC.