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

Annals of Surgical Oncology - Tập 24 - Trang 1343-1350 - 2016
Cecilia G. Ethun1, Lauren M. Postlewait1, Nina Le1, Timothy M. Pawlik2, Stefan Buettner2, George Poultsides3, Thuy Tran3, Kamran Idrees4, Chelsea A. Isom4, Ryan C. Fields5, Linda X. Jin5, Sharon M. Weber6, Ahmed Salem6, Robert C. G. Martin7, Charles Scoggins7, Perry Shen8, Harveshp D. Mogal9, Carl Schmidt10, Eliza Beal10, Ioannis Hatzaras11, Rivfka Shenoy11, Nipun Merchant4,12, Kenneth Cardona1, Shishir K. Maithel1
1Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, USA
2Division of Surgical Oncology, Department of Surgery, The Johns Hopkins Hospital, Baltimore, USA
3Department of Surgery, Stanford University Medical Center, Stanford, USA
4Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, USA
5Department of Surgery, Washington University School of Medicine, St. Louis, USA
6Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, USA
7Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, USA
8Department of Surgery, Wake Forest University, Winston-Salem, USA
9Department of Surgery, Wake Forest University, Winston Salem, USA
10Division of Surgical Oncology, Department of Surgery, The Ohio State University Comprehensive Cancer Center, Columbus, USA
11Department of Surgery, New York University, New York, USA
12Division of Surgical Oncology, Department of Surgery, University of Miami, Miami, USA

Tóm tắt

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. 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). 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. 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.

Tài liệu tham khảo

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Annals of Surgical Oncology

Tập 24

1343-1350

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