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

Publication ,  Journal Article
Creasy, JM; Goldman, DA; Gonen, M; Dudeja, V; Askan, G; Basturk, O; Balachandran, VP; Allen, PJ; DeMatteo, RP; D'Angelica, MI; Jarnagin, WR ...
Published in: J Gastrointest Surg
August 2017

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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Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

August 2017

Volume

21

Issue

8

Start / End Page

1254 / 1261

Location

Netherlands

Related Subject Headings

  • Surgery
  • Risk Assessment
  • Reoperation
  • Prospective Studies
  • Neoplasm, Residual
  • Neoplasm Staging
  • Neoplasm Grading
  • Multivariate Analysis
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Creasy, J. M., Goldman, D. A., Gonen, M., Dudeja, V., Askan, G., Basturk, O., … Peter Kingham, T. (2017). Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies. J Gastrointest Surg, 21(8), 1254–1261. https://doi.org/10.1007/s11605-017-3436-8
Creasy, John M., Debra A. Goldman, Mithat Gonen, Vikas Dudeja, Gokce Askan, Olca Basturk, Vinod P. Balachandran, et al. “Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies.J Gastrointest Surg 21, no. 8 (August 2017): 1254–61. https://doi.org/10.1007/s11605-017-3436-8.
Creasy JM, Goldman DA, Gonen M, Dudeja V, Askan G, Basturk O, et al. Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies. J Gastrointest Surg. 2017 Aug;21(8):1254–61.
Creasy, John M., et al. “Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies.J Gastrointest Surg, vol. 21, no. 8, Aug. 2017, pp. 1254–61. Pubmed, doi:10.1007/s11605-017-3436-8.
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. Predicting Residual Disease in Incidental Gallbladder Cancer: Risk Stratification for Modified Treatment Strategies. J Gastrointest Surg. 2017 Aug;21(8):1254–1261.
Journal cover image

Published In

J Gastrointest Surg

DOI

EISSN

1873-4626

Publication Date

August 2017

Volume

21

Issue

8

Start / End Page

1254 / 1261

Location

Netherlands

Related Subject Headings

  • Surgery
  • Risk Assessment
  • Reoperation
  • Prospective Studies
  • Neoplasm, Residual
  • Neoplasm Staging
  • Neoplasm Grading
  • Multivariate Analysis
  • Middle Aged
  • Male