Predicting residual disease in incidental gallbladder cancer: Risk stratification for modified treatment strategies Journal Article

Authors: Creasy, J. M.; Goldman, D. A.; Gonen, M.; Dudeja, V.; Askan, G.; Basturk, O.; Balachandran, V. P.; Allen, P. J.; DeMatteo, R. P.; D’Angelica, M. I.; Jarnagin, W. R.; Kingham, T. P.
Article Title: Predicting residual disease in incidental gallbladder cancer: Risk stratification for modified treatment strategies
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. © 2017, The Society for Surgery of the Alimentary Tract.
Keywords: residual disease; gbca; incidental gallbladder carcinoma
Journal Title: Journal of Gastrointestinal Surgery
Volume: 21
Issue: 8
ISSN: 1091-255X
Publisher: Springer  
Date Published: 2017-08-01
Start Page: 1254
End Page: 1261
Language: English
DOI: 10.1007/s11605-017-3436-8
PROVIDER: scopus
PMCID: PMC5521173
PUBMED: 28484891
Notes: Article -- Export Date: 1 August 2017 -- Source: Scopus
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MSK Authors
  1. Ronald P DeMatteo
    605 DeMatteo
  2. Mithat Gonen
    721 Gonen
  3. Olca Basturk
    204 Basturk
  4. Peter Allen
    445 Allen
  5. William R Jarnagin
    598 Jarnagin
  6. T Peter Kingham
    295 Kingham
  7. Debra Alyssa Goldman
    98 Goldman
  8. Vikas Dudeja
    3 Dudeja
  9. Gokce Askan
    41 Askan
  10. John Creasy
    9 Creasy