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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

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

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.

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA

    Cecilia G. Ethun MD, Lauren M. Postlewait MD, Nina Le BS, Kenneth Cardona MD & Shishir K. Maithel MD

  2. Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD & Stefan Buettner MD

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

    George Poultsides MD & Thuy Tran MD

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

    Kamran Idrees MD, Chelsea A. Isom MD & Nipun Merchant MD

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

    Ryan C. Fields MD & Linda X. Jin MD

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

    Sharon M. Weber MD & Ahmed Salem MD

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

    Robert C. G. Martin MD, PhD & Charles Scoggins MD

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

    Perry Shen MD & Harveshp D. Mogal MD

  9. Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA

    Carl Schmidt MD & Eliza Beal MD

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

    Ioannis Hatzaras MD & Rivfka Shenoy MD

  11. Division of Surgical Oncology, Department of Surgery, University of Miami, Miami, FL, USA

    Nipun Merchant MD

Authors
  1. Cecilia G. Ethun MD
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  2. Lauren M. Postlewait MD
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  3. Nina Le BS
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  4. Timothy M. Pawlik MD, MPH, PhD
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  5. Stefan Buettner MD
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  6. George Poultsides MD
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  7. Thuy Tran MD
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  8. Kamran Idrees MD
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  9. Chelsea A. Isom MD
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  10. Ryan C. Fields MD
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  11. Linda X. Jin MD
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  12. Sharon M. Weber MD
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  13. Ahmed Salem MD
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  14. Robert C. G. Martin MD, PhD
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  15. Charles Scoggins MD
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  16. Perry Shen MD
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  17. Harveshp D. Mogal MD
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  18. Carl Schmidt MD
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  19. Eliza Beal MD
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  20. Ioannis Hatzaras MD
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  21. Rivfka Shenoy MD
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  22. Nipun Merchant MD
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  23. Kenneth Cardona MD
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  24. Shishir K. Maithel MD
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Corresponding author

Correspondence to Shishir K. Maithel MD.

Additional information

This study was an Oral Presentation at the Society of Surgical Oncology Annual Meeting 2016, and a Poster Presentation at the Gastrointestinal Cancer Symposium (ASCO-GI) 2016.

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Ethun, C.G., Postlewait, L.M., Le, N. et al. 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. Ann Surg Oncol 24, 1343–1350 (2017). https://doi.org/10.1245/s10434-016-5637-x

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  • DOI: https://doi.org/10.1245/s10434-016-5637-x

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