P2192 - Jaundice in Gallbladder Cancer: Tumor Biology Beyond Biliary Obstruction and Comparative Survival Outcomes in 199 Patients

Utpal Anand, MBBS, MS, MCh, Abhishek Arora, MBBS, MS
All India Institute of Medical Sciences Patna, Patna, Bihar, India

Introduction: This study evaluates whether jaundice in gallbladder cancer (GBC) reflects distinct tumor biology or is solely due to proximal tumor location causing biliary obstruction, and compares survival predictors in jaundiced vs. non-jaundiced patients.

Methods: Prospective analysis of 199 GBC patients (116 jaundiced, 83 non-jaundiced). Clinicopathological profiles, resectability, and survival were analyzed using logistic and Cox regression. Kaplan–Meier analysis and adjusted Cox models were applied in both the overall and resected cohorts.

Results: Tumor Biology vs. Location: Jaundiced patients had higher rates of proximal tumor location (73.3% vs. 19.3%; aOR 3.4, p=0.034) and CHD/CBD infiltration (94.8% vs. 14.5%; aOR 76, p< 0.001), but also exhibited aggressive biology: advanced T-stage (≥T3: 58.8% vs. 13.3%), perineural invasion (47.1% vs. 16.7%), and elevated CA 19-9 (75% vs. 36.1%) (p< 0.05 for all).

Resectability/Survival: Only 17.2% of jaundiced patients were resectable vs. 45.8% non-jaundiced (p< 0.001). Among resected patients, jaundiced cases had significantly worse survival (HR 4.45, 95% CI: 1.15–17.31, p=0.031). In the overall cohort, even after accounting for tumor epicenter, jaundice remained a strong independent predictor of worse survival (HR 2.14, 95% CI: 1.46–3.14, p< 0.001).

Table: Key Preoperative factors and Survival Profile in Jaundiced vs. Non-Jaundiced GBC Patients (n=199)

Parameter	Jaundice		P value (χ²/Fisher’s)
	Yes (n=116)	No (n=83)
Liver involvement	90 (77.6%)	55 (66.3%)	0.096
Adjacent organ invasion	39 (33.6%)	27 (32.53%)	0.872
Vascular invasion (any)	64 (55.2%)	33 (39.8%)	0.032
Metastatic disease on presentation	67 (57.7%)	44 (53.0%)	0.506
Resectability	20 (17.2%)	38 (45.7%)	< 0.001
1-year survival	17 (14.6%)	37 (44.5%)	< 0.001

Discussion: Jaundice in GBC signifies both obstructive tumor location and aggressive biology. Even resectable jaundiced patients harbor high-risk features and experience inferior survival, underscoring the need for early detection and individualized strategies.

Disclosures:
Utpal Anand indicated no relevant financial relationships.
Abhishek Arora indicated no relevant financial relationships.

Utpal Anand, MBBS, MS, MCh, Abhishek Arora, MBBS, MS. P2192 - Jaundice in Gallbladder Cancer: Tumor Biology Beyond Biliary Obstruction and Comparative Survival Outcomes in 199 Patients, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.