S156 Jaundice in Gallbladder Cancer: Tumor Biology Beyond Biliary Obstruction and Comparative Survival Outcomes in 199 Patients

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%; adjusted odds ratio 3.4, P = 0.034) and CHD/CBD infiltration (94.8% vs 14.5%; adjusted odds ratio 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). Conclusion: 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.