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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    John M. Creasy, Vikas Dudeja, Vinod P. Balachandran, Peter J. Allen, Ronald P. DeMatteo, Michael I. D’Angelica, William R. Jarnagin & T. Peter Kingham

  2. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Debra A. Goldman & Mithat Gonen

  3. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Gokce Askan & Olca Basturk

Authors
  1. John M. Creasy
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  2. Debra A. Goldman
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  3. Mithat Gonen
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  4. Vikas Dudeja
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  5. Gokce Askan
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  6. Olca Basturk
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  7. Vinod P. Balachandran
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  8. Peter J. Allen
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  9. Ronald P. DeMatteo
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  10. Michael I. D’Angelica
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  11. William R. Jarnagin
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  12. T. Peter Kingham
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Contributions

All authors met criteria for authorship based on contributions to the manuscript in submission.

Corresponding author

Correspondence to T. Peter Kingham.

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Funding

This work was supported in part by the NIH/NCI P30 CA008748 Cancer Center Support Grant.

Conflict of Interest

The authors declare that they have no conflicts of interest.

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Creasy, J.M., Goldman, D.A., Gonen, M. et al. Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies. J Gastrointest Surg 21, 1254–1261 (2017). https://doi.org/10.1007/s11605-017-3436-8

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  • DOI: https://doi.org/10.1007/s11605-017-3436-8

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