Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies

John M Creasy; Debra A Goldman; Mithat Gonen; Vikas Dudeja; Gokce Askan; Olca Basturk; Vinod P Balachandran; Peter J Allen; Ronald P DeMatteo; Michael I D'Angelica; William R Jarnagin; T Peter Kingham

doi:10.1007/s11605-017-3436-8

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Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies

Journal article

Peer reviewed

Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies

John M Creasy, Debra A Goldman, Mithat Gonen, Vikas Dudeja, Gokce Askan, Olca Basturk, Vinod P Balachandran, Peter J Allen, Ronald P DeMatteo, Michael I D'Angelica, …

Journal of gastrointestinal surgery, Vol.21(8), pp.1254-1261

08/01/2017

DOI: 10.1007/s11605-017-3436-8

PMID: 28484891

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Abstract

Re-operation is advised for patients with T1b or greater incidental gallbladder cancer (GBCA). The presence of residual disease (RD) impacts resectability, chemotherapy, and survival. This study created a preoperative model to predict RD at re-operation. Patients with re-operation for incidental GBCA from 1992-2015 were included. The relationship between pathology data from initial cholecystectomy and RD at re-operation was assessed with logistic regression and classification and regression tree (CART) analysis. Two hundred fifty-four patients were included and 188 underwent definitive re-resection (74.0%). Distant RD was identified in 69 (27.2%) patients and locoregional only RD in 82 (32.3%). On multivariate analysis, T3 (OR 22.7, 95% CI 5.5-94.4) and poorly differentiated tumors (OR 4.3, 95% CI 1.4-13.3) were associated with RD (p < 0.001-0.012). AUC of multivariate model was 0.78 (95% CI 0.72-0.83). CART analysis split patients into groups based on percentage with RD: 87% RD with T3, 67% RD with T1b/T2 and poorly differentiated, and 35% RD with T1b/T2 and well/moderate differentiated tumors. Based on T stage and grade from cholecystectomy, this study developed a model for predicting RD at re-operation in incidental GBCA. This model delineates patient groups with variable percentages of RD and could be used to stratify high-risk patients for prospective trials.

Adult

Aged

Aged, 80 and over

Cholecystectomy

Female

Gallbladder Neoplasms - mortality

Gallbladder Neoplasms - pathology

Gallbladder Neoplasms - surgery

Humans

Incidental Findings

Male

Middle Aged

Multivariate Analysis

Neoplasm Grading

Neoplasm Staging

Neoplasm, Residual

Prospective Studies

Reoperation

Risk Assessment - methods

Details

Title: Subtitle: Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies
Creators: John M Creasy - Memorial Sloan Kettering Cancer Center
Debra A Goldman - Memorial Sloan Kettering Cancer Center
Mithat Gonen - Memorial Sloan Kettering Cancer Center
Vikas Dudeja - Memorial Sloan Kettering Cancer Center
Gokce Askan - Memorial Sloan Kettering Cancer Center
Olca Basturk - Memorial Sloan Kettering Cancer Center
Vinod P Balachandran - Memorial Sloan Kettering Cancer Center
Peter J Allen - Memorial Sloan Kettering Cancer Center
Ronald P DeMatteo - Memorial Sloan Kettering Cancer Center
Michael I D'Angelica - Memorial Sloan Kettering Cancer Center
William R Jarnagin - Memorial Sloan Kettering Cancer Center
T Peter Kingham - Memorial Sloan Kettering Cancer Center
Resource Type: Journal article
Publication Details: Journal of gastrointestinal surgery, Vol.21(8), pp.1254-1261
DOI: 10.1007/s11605-017-3436-8
PMID: 28484891
NLM abbreviation: J Gastrointest Surg
ISSN: 1091-255X
eISSN: 1873-4626
Grant note: P30 CA008748 / NCI NIH HHS
Language: English
Date published: 08/01/2017
Academic Unit: Anatomy and Cell Biology; Surgery
Record Identifier: 9985244676402771

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