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

John M. Creasy, Debra A. Goldman, Mithat Gonen, Vikas Dudeja, Gokce Askan, Olca Basturk, Vinod P. Balachandran, Peter J. Allen, Ronald P. DeMatteo, Michael I. D’Angelica, William R. Jarnagin, T. Peter Kingham

Research output: Contribution to journalArticle

12 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1254-1261
Number of pages8
JournalJournal of Gastrointestinal Surgery
Volume21
Issue number8
DOIs
StatePublished - Aug 1 2017
Externally publishedYes

Fingerprint

Gallbladder Neoplasms
Therapeutics
Cholecystectomy
Regression Analysis
Area Under Curve
Neoplasms

Keywords

  • GBCA
  • Incidental gallbladder carcinoma
  • Residual disease

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Predicting Residual Disease in Incidental Gallbladder Cancer : Risk Stratification for Modified Treatment Strategies. / Creasy, John M.; Goldman, Debra A.; Gonen, Mithat; Dudeja, Vikas; Askan, Gokce; Basturk, Olca; Balachandran, Vinod P.; Allen, Peter J.; DeMatteo, Ronald P.; D’Angelica, Michael I.; Jarnagin, William R.; Peter Kingham, T.

In: Journal of Gastrointestinal Surgery, Vol. 21, No. 8, 01.08.2017, p. 1254-1261.

Research output: Contribution to journalArticle

Creasy, JM, Goldman, DA, Gonen, M, Dudeja, V, Askan, G, Basturk, O, Balachandran, VP, Allen, PJ, DeMatteo, RP, D’Angelica, MI, Jarnagin, WR & Peter Kingham, T 2017, 'Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies', Journal of Gastrointestinal Surgery, vol. 21, no. 8, pp. 1254-1261. https://doi.org/10.1007/s11605-017-3436-8
Creasy, John M. ; Goldman, Debra A. ; Gonen, Mithat ; Dudeja, Vikas ; Askan, Gokce ; Basturk, Olca ; Balachandran, Vinod P. ; Allen, Peter J. ; DeMatteo, Ronald P. ; D’Angelica, Michael I. ; Jarnagin, William R. ; Peter Kingham, T. / Predicting Residual Disease in Incidental Gallbladder Cancer : Risk Stratification for Modified Treatment Strategies. In: Journal of Gastrointestinal Surgery. 2017 ; Vol. 21, No. 8. pp. 1254-1261.
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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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T1 - Predicting Residual Disease in Incidental Gallbladder Cancer

T2 - Risk Stratification for Modified Treatment Strategies

AU - Creasy, John M.

AU - Goldman, Debra A.

AU - Gonen, Mithat

AU - Dudeja, Vikas

AU - Askan, Gokce

AU - Basturk, Olca

AU - Balachandran, Vinod P.

AU - Allen, Peter J.

AU - DeMatteo, Ronald P.

AU - D’Angelica, Michael I.

AU - Jarnagin, William R.

AU - Peter Kingham, T.

PY - 2017/8/1

Y1 - 2017/8/1

N2 - 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.

AB - 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.

KW - GBCA

KW - Incidental gallbladder carcinoma

KW - Residual disease

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