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Defining and Predicting Early Recurrence after Resection for Gallbladder Cancer

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

The optimal time interval to define early recurrence (ER) among patients who underwent resection of gallbladder cancer (GBC) is not well defined. We sought to develop and validate a novel GBC recurrence risk (GBRR) score to predict ER among patients undergoing resection for GBC.

Patients and Methods

Patients who underwent curative-intent resection for GBC between 2000 and 2018 were identified from the US Extrahepatic Biliary Malignancy Consortium database. A minimum p value approach in the log-rank test was used to define the optimal cutoff for ER. A risk stratification model was developed to predict ER based on relevant clinicopathological factors and was externally validated.

Results

Among 309 patients, 103 patients (33.3%) had a recurrence at a median follow-up period of 15.1 months. The optimal cutoff for ER was defined at 12 months (p = 3.04 × 10−18). On multivariable analysis, T3/T4 disease (HR: 2.80; 95% CI 1.58–5.11) and poor tumor differentiation (HR: 1.91; 95% CI 1.11–3.25) were associated with greater hazards of ER. The GBRR score was developed using β-coefficients of variables in the final model, and patients were classified into three distinct groups relative to the risk for ER (12-month RFS; low risk: 88.4%, intermediate risk: 77.9%, high risk: 37.0%, p < 0.001). The external validation demonstrated good model generalizability with good calibration (n = 102: 12-month RFS; low risk: 94.2%, intermediate risk: 59.8%, high risk: 42.0%, p < 0.001). The GBRR score is available online at https://ktsahara.shinyapps.io/GBC_earlyrec/.

Conclusions

A novel online calculator was developed to help clinicians predict the probability of ER after curative-intent resection for GBC. The proposed web-based tool may help in the optimization of surveillance intervals and the counselling of patients about their prognosis.

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Acknowledgments

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Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan

    Kota Sahara MD, Yutaro Kikuchi MD, PhD, Yasuhiro Yabushita MD, PhD, Ryusei Matsuyama MD, PhD & Itaru Endo MD, PhD

  2. Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA

    Kota Sahara MD, Diamantis I. Tsilimigras MD, Yutaro Kikuchi MD, PhD & Timothy M. Pawlik MD, MPH, PhD, FACS

  3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA

    Cecilia G. Ethun MD & Shishir K. Maithel MD

  4. Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA

    Daniel E. Abbott MD

  5. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA

    George A. Poultsides MD

  6. Department of Surgery, New York University, New York, NY, USA

    Ioannis Hatzaras MD

  7. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Ryan C. Fields MD

  8. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Matthew Weiss MD

  9. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA

    Charles Scoggins MD

  10. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Chelsea A. Isom MD & Kamran Idrees MD

  11. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA

    Perry Shen MD

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  1. Kota Sahara MD
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  2. Diamantis I. Tsilimigras MD
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  18. Timothy M. Pawlik MD, MPH, PhD, FACS
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Corresponding author

Correspondence to Timothy M. Pawlik MD, MPH, PhD, FACS.

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Sahara, K., Tsilimigras, D.I., Kikuchi, Y. et al. Defining and Predicting Early Recurrence after Resection for Gallbladder Cancer. Ann Surg Oncol 28, 417–425 (2021). https://doi.org/10.1245/s10434-020-09108-y

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