Postoperative prognostic factors in patients with T2 gallbladder cancer: a meta-analysis

This study aimed to examine postoperative prognostic factors in patients with T2 gallbladder cancer (GBC) to determine factors linked to survival outcomes. The results can inform clinical decision-making and guide personalized treatment plans. The Cochrane Library, PubMed, Web of Science, and Embase databases were retrieved up to March 12, 2025. The included articles were scored via the Newcastle-Ottawa Scale (NOS). The data were analyzed via Stata 15.0. Twenty-one studies (n = 8,095) were included. Factors associated with worse overall survival (OS) included age > 60 years (hazard ratio [HR] = 1.02, 95% confidence interval [CI]: 1.00–1.05) and hepatic-side tumors (HR = 2.89, 95% CI: 2.14–3.90). There was a non-significant trend toward poorer OS with male sex (HR = 1.41, 95% CI: 0.89–2.23). Several associations became significant after sensitivity analyses eliminated sources of heterogeneity: lymph node (LN) metastasis (HR = 2.18, 95% CI: 1.56–3.07), perineural invasion (PNI) (HR = 2.29, 95% CI: 1.74–3.03), simple cholecystectomy (SC) (HR = 1.46, 95% CI: 1.00–2.13), and extended cholecystectomy (EC), the latter of which was protective (HR = 0.67, 95% CI: 0.52–0.87). Additional protective factors included LN dissection (HR = 0.57, 95% CI: 0.38–0.86) and R0 resection (HR = 0.21, 95% CI: 0.05–0.91). For disease-free survival (DFS), LN metastasis (HR = 2.46, 95% CI: 1.50–4.04) and PNI (HR = 2.03, 95% CI: 1.36–3.04) were independent predictors of a poor outcome, which was confirmed again after sensitivity analyses. For postoperative patients with T2 GBC, factors, including age > 60 years, male gender, hepatic lateral tumor, LN metastasis, PNI, and SC were linked to worse OS. LN metastasis and PNI significantly affected DFS. EC and LN dissection may improve prognosis.