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Annals of Surgical Oncology

, Volume 24, Issue 5, pp 1343–1350 | Cite as

A Novel Pathology-Based Preoperative Risk Score to Predict Locoregional Residual and Distant Disease and Survival for Incidental Gallbladder Cancer: A 10-Institution Study from the U.S. Extrahepatic Biliary Malignancy Consortium

  • Cecilia G. Ethun
  • Lauren M. Postlewait
  • Nina Le
  • Timothy M. Pawlik
  • Stefan Buettner
  • George Poultsides
  • Thuy Tran
  • Kamran Idrees
  • Chelsea A. Isom
  • Ryan C. Fields
  • Linda X. Jin
  • Sharon M. Weber
  • Ahmed Salem
  • Robert C. G. Martin
  • Charles Scoggins
  • Perry Shen
  • Harveshp D. Mogal
  • Carl Schmidt
  • Eliza Beal
  • Ioannis Hatzaras
  • Rivfka Shenoy
  • Nipun Merchant
  • Kenneth Cardona
  • Shishir K. MaithelEmail author
Hepatobiliary Tumors

Abstract

Background

This study was designed to develop a more robust predictive model, beyond T-stage alone, for incidental gallbladder cancer (IGBC) for discovering locoregional residual (LRD) and distant disease (DD) at reoperation, and estimating overall survival (OS). T-stage alone is currently used to guide treatment for incidental gallbladder cancer. Residual disease at re-resection is the most important factor in predicting outcomes.

Methods

All patients with IGBC who underwent reoperation at 10 institutions from 2000 to 2015 were included. Routine pathology data from initial cholecystectomy was utilized to create the gallbladder cancer predictive risk score (GBRS).

Results

Of 449 patients with gallbladder cancer, 262 (58 %) were incidentally discovered and underwent reoperation. Advanced T-stage, grade, and presence of lymphovascular (LVI) and perineural (PNI) invasion were all associated with increased rates of DD and LRD and decreased OS. Each pathologic characteristic was assigned a value (T1a: 0, T1b: 1, T2: 2, T3/4: 3; well-diff: 1, mod-diff: 2, poor-diff: 3; LVI-neg: 1, LVI-pos: 2; PNI-neg: 1, PNI-pos: 2), which added to a total GBRS score from 3 to 10. The scores were separated into three risk-groups (low: 3–4, intermediate: 5–7, high: 8–10). Each progressive GBRS group was associated with an increased incidence LRD and DD at the time of re-resection and reduced OS.

Conclusions

By accounting for subtle pathologic variations within each T-stage, this novel predictive risk-score better stratifies patients with incidentally discovered gallbladder cancer. Compared with T-stage alone, it more accurately identifies patients at risk for locoregional-residual and distant disease and predicts long-term survival as it redistributes T1b, T2, and T3 disease across separate risk-groups based on additional biologic features. This score may help to optimize treatment strategy for patients with incidentally discovered gallbladder cancer.

Keywords

Overall Survival Residual Disease Gallbladder Cancer Gallbladder Carcinoma Distant Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Disclosure

None.

Supplementary material

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Supplementary material 1 (DOCX 14 kb)
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Supplementary material 2 (DOCX 14 kb)
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Supplementary material 3 (TIFF 78 kb)
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Supplementary material 4 (DOCX 12 kb)

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Copyright information

© Society of Surgical Oncology 2016

Authors and Affiliations

  • Cecilia G. Ethun
    • 1
  • Lauren M. Postlewait
    • 1
  • Nina Le
    • 1
  • Timothy M. Pawlik
    • 2
  • Stefan Buettner
    • 2
  • George Poultsides
    • 3
  • Thuy Tran
    • 3
  • Kamran Idrees
    • 4
  • Chelsea A. Isom
    • 4
  • Ryan C. Fields
    • 5
  • Linda X. Jin
    • 5
  • Sharon M. Weber
    • 6
  • Ahmed Salem
    • 6
  • Robert C. G. Martin
    • 7
  • Charles Scoggins
    • 7
  • Perry Shen
    • 8
  • Harveshp D. Mogal
    • 8
  • Carl Schmidt
    • 9
  • Eliza Beal
    • 9
  • Ioannis Hatzaras
    • 10
  • Rivfka Shenoy
    • 10
  • Nipun Merchant
    • 4
    • 11
  • Kenneth Cardona
    • 1
  • Shishir K. Maithel
    • 1
    Email author
  1. 1.Division of Surgical Oncology, Department of Surgery, Winship Cancer InstituteEmory UniversityAtlantaUSA
  2. 2.Division of Surgical Oncology, Department of SurgeryThe Johns Hopkins HospitalBaltimoreUSA
  3. 3.Department of SurgeryStanford University Medical CenterStanfordUSA
  4. 4.Division of Surgical Oncology, Department of SurgeryVanderbilt University Medical CenterNashvilleUSA
  5. 5.Department of SurgeryWashington University School of MedicineSt LouisUSA
  6. 6.Department of SurgeryUniversity of Wisconsin School of Medicine and Public HealthMadisonUSA
  7. 7.Division of Surgical Oncology, Department of SurgeryUniversity of LouisvilleLouisvilleUSA
  8. 8.Department of SurgeryWake Forest UniversityWinston-SalemUSA
  9. 9.Division of Surgical Oncology, Department of SurgeryThe Ohio State University Comprehensive Cancer CenterColumbusUSA
  10. 10.Department of SurgeryNew York UniversityNew YorkUSA
  11. 11.Division of Surgical Oncology, Department of SurgeryUniversity of MiamiMiamiUSA

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