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

Cecilia G. Ethun, Lauren M. Postlewait, Nina Le, Timothy M. Pawlik, Stefan Buettner, George Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Linda X. Jin, Sharon M. Weber, Ahmed Salem, Robert C G Martin, Charles Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza Beal, Ioannis Hatzaras & 4 others Rivfka Shenoy, Nipun Merchant, Kenneth Cardona, Shishir K. Maithel

Research output: Contribution to journalArticle

22 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1-8
Number of pages8
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Nov 3 2016

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Gallbladder Neoplasms
antineoplaston A10
Pathology
Survival
Neoplasms
Reoperation
Cholecystectomy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

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. / Ethun, Cecilia G.; Postlewait, Lauren M.; Le, Nina; Pawlik, Timothy M.; Buettner, Stefan; Poultsides, George; Tran, Thuy; Idrees, Kamran; Isom, Chelsea A.; Fields, Ryan C.; Jin, Linda X.; Weber, Sharon M.; Salem, Ahmed; Martin, Robert C G; Scoggins, Charles; Shen, Perry; Mogal, Harveshp D.; Schmidt, Carl; Beal, Eliza; Hatzaras, Ioannis; Shenoy, Rivfka; Merchant, Nipun; Cardona, Kenneth; Maithel, Shishir K.

In: Annals of Surgical Oncology, 03.11.2016, p. 1-8.

Research output: Contribution to journalArticle

Ethun, CG, Postlewait, LM, Le, N, Pawlik, TM, Buettner, S, Poultsides, G, Tran, T, Idrees, K, Isom, CA, Fields, RC, Jin, LX, Weber, SM, Salem, A, Martin, RCG, Scoggins, C, Shen, P, Mogal, HD, Schmidt, C, Beal, E, Hatzaras, I, Shenoy, R, Merchant, N, Cardona, K & Maithel, SK 2016, '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, pp. 1-8. https://doi.org/10.1245/s10434-016-5637-x
Ethun, Cecilia G. ; Postlewait, Lauren M. ; Le, Nina ; Pawlik, Timothy M. ; Buettner, Stefan ; Poultsides, George ; Tran, Thuy ; Idrees, Kamran ; Isom, Chelsea A. ; Fields, Ryan C. ; Jin, Linda X. ; Weber, Sharon M. ; Salem, Ahmed ; Martin, Robert C G ; Scoggins, Charles ; Shen, Perry ; Mogal, Harveshp D. ; Schmidt, Carl ; Beal, Eliza ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Merchant, Nipun ; Cardona, Kenneth ; Maithel, Shishir K. / 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. In: Annals of Surgical Oncology. 2016 ; pp. 1-8.
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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.",
author = "Ethun, {Cecilia G.} and Postlewait, {Lauren M.} and Nina Le and Pawlik, {Timothy M.} and Stefan Buettner and George Poultsides and Thuy Tran and Kamran Idrees and Isom, {Chelsea A.} and Fields, {Ryan C.} and Jin, {Linda X.} and Weber, {Sharon M.} and Ahmed Salem and Martin, {Robert C G} and Charles Scoggins and Perry Shen and Mogal, {Harveshp D.} and Carl Schmidt and Eliza Beal and Ioannis Hatzaras and Rivfka Shenoy and Nipun Merchant and Kenneth Cardona and Maithel, {Shishir K.}",
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T1 - A Novel Pathology-Based Preoperative Risk Score to Predict Locoregional Residual and Distant Disease and Survival for Incidental Gallbladder Cancer

T2 - A 10-Institution Study from the U.S. Extrahepatic Biliary Malignancy Consortium

AU - Ethun, Cecilia G.

AU - Postlewait, Lauren M.

AU - Le, Nina

AU - Pawlik, Timothy M.

AU - Buettner, Stefan

AU - Poultsides, George

AU - Tran, Thuy

AU - Idrees, Kamran

AU - Isom, Chelsea A.

AU - Fields, Ryan C.

AU - Jin, Linda X.

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Martin, Robert C G

AU - Scoggins, Charles

AU - Shen, Perry

AU - Mogal, Harveshp D.

AU - Schmidt, Carl

AU - Beal, Eliza

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Merchant, Nipun

AU - Cardona, Kenneth

AU - Maithel, Shishir K.

PY - 2016/11/3

Y1 - 2016/11/3

N2 - 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.

AB - 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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