CÁNCER DE VESÍCULA BILIAR: APORTES DE LA CIENCIA CHILENA A UN PROBLEMA DE SALUD PÚBLICA GLOBALMENTE DESIGUAL

Background: Gallbladder cancer (GBC) is a highly lethal malignancy with striking geographic disparities. Chile consistently reports among the highest global incidence and mortality rates, particularly affecting women and indigenous populations in the southern regions. This epide- miological reality has driven an intensive national research agenda over the past three decades, yielding contributions of global significance. Findings: Chilean studies have been instrumental in clarifying the natural history of GBC. Clinical and population-based cohorts established the lithiasis-dysplasia-carcinoma sequence, defined timelines of progression from preneoplastic lesions, and provided the rationale for preventive cholecystectomy policies. Genomic and an- cestry-based research identified genetic variants and susceptibilities unique to Chilean popula- tions, while investigations into environmental and infectious exposures-such as chronic enteric bacterial infection and aflatoxin exposure-highlighted their roles in gallbladder carcinogenesis. In the field of molecular pathology, Chilean contributions include the characterization of tu- mor suppressor gene inactivation, oncogene activation, and epigenetic dysregulation, together with the development of translational predictive models that integrate clinical and molecular variables. Participation in international consortia has led to incorporation of these findings into consensus classifications, reporting standards, and staging systems. Surgical innovation in Chile advanced the stlocalization and radical resection, demonstrated the prognostic impact of tumor localization and validated minimally invasive approaches. Oncologic management has also evolved with evidence supporting combined chemotherapy regimens, as well as the incorporation of adjuvant and neoadjuvant strategies in high-risk subsets. Conclusions: Collectively, these contributions underscore the pivotal role of Chilean science in global understanding of GBC. By integrating epidemiology, pathology, molecular biology, surgery, and oncology, Chile has emerged as a reference point in a historically neglected malignancy. This body of work high- lights both the scientific and public health relevance of GBC in high-incidence settings, while providing a model of how regionally driven research can influence international standards of cancer prevention, diagnosis, and treatment.