Kota Sahara1,2, Diamantis I Tsilimigras2, Yutaro Kikuchi1,2, Cecilia G Ethun3, Shishir K Maithel3, Daniel E Abbott4, George A Poultsides5, Ioannis Hatzaras6, Ryan C Fields7, Matthew Weiss8, Charles Scoggins9, Chelsea A Isom10, Kamran Idrees10, Perry Shen11, Yasuhiro Yabushita1, Ryusei Matsuyama1, Itaru Endo1, Timothy M Pawlik12. 1. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan. 2. Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA. 3. Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute, Emory University, Atlanta, GA, USA. 4. Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA. 5. Department of Surgery, Stanford University Medical Center, Stanford, CA, USA. 6. Department of Surgery, New York University, New York, NY, USA. 7. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA. 8. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA. 9. Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA. 10. Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. 11. Department of Surgery, Wake Forest University, Winston-Salem, NC, USA. 12. Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, James Comprehensive Cancer Center, The Ohio State University Wexner Medical Center, Columbus, OH, USA. Tim.Pawlik@osumc.edu.
Abstract
BACKGROUND: The optimal time interval to define early recurrence (ER) among patients who underwent resection of gallbladder cancer (GBC) is not well defined. We sought to develop and validate a novel GBC recurrence risk (GBRR) score to predict ER among patients undergoing resection for GBC. PATIENTS AND METHODS: Patients who underwent curative-intent resection for GBC between 2000 and 2018 were identified from the US Extrahepatic Biliary Malignancy Consortium database. A minimum p value approach in the log-rank test was used to define the optimal cutoff for ER. A risk stratification model was developed to predict ER based on relevant clinicopathological factors and was externally validated. RESULTS: Among 309 patients, 103 patients (33.3%) had a recurrence at a median follow-up period of 15.1 months. The optimal cutoff for ER was defined at 12 months (p = 3.04 × 10-18). On multivariable analysis, T3/T4 disease (HR: 2.80; 95% CI 1.58-5.11) and poor tumor differentiation (HR: 1.91; 95% CI 1.11-3.25) were associated with greater hazards of ER. The GBRR score was developed using β-coefficients of variables in the final model, and patients were classified into three distinct groups relative to the risk for ER (12-month RFS; low risk: 88.4%, intermediate risk: 77.9%, high risk: 37.0%, p < 0.001). The external validation demonstrated good model generalizability with good calibration (n = 102: 12-month RFS; low risk: 94.2%, intermediate risk: 59.8%, high risk: 42.0%, p < 0.001). The GBRR score is available online at https://ktsahara.shinyapps.io/GBC_earlyrec/ . CONCLUSIONS: A novel online calculator was developed to help clinicians predict the probability of ER after curative-intent resection for GBC. The proposed web-based tool may help in the optimization of surveillance intervals and the counselling of patients about their prognosis.
BACKGROUND: The optimal time interval to define early recurrence (ER) among patients who underwent resection of gallbladder cancer (GBC) is not well defined. We sought to develop and validate a novel GBC recurrence risk (GBRR) score to predict ER among patients undergoing resection for GBC. PATIENTS AND METHODS: Patients who underwent curative-intent resection for GBC between 2000 and 2018 were identified from the US Extrahepatic Biliary Malignancy Consortium database. A minimum p value approach in the log-rank test was used to define the optimal cutoff for ER. A risk stratification model was developed to predict ER based on relevant clinicopathological factors and was externally validated. RESULTS: Among 309 patients, 103 patients (33.3%) had a recurrence at a median follow-up period of 15.1 months. The optimal cutoff for ER was defined at 12 months (p = 3.04 × 10-18). On multivariable analysis, T3/T4 disease (HR: 2.80; 95% CI 1.58-5.11) and poor tumor differentiation (HR: 1.91; 95% CI 1.11-3.25) were associated with greater hazards of ER. The GBRR score was developed using β-coefficients of variables in the final model, and patients were classified into three distinct groups relative to the risk for ER (12-month RFS; low risk: 88.4%, intermediate risk: 77.9%, high risk: 37.0%, p < 0.001). The external validation demonstrated good model generalizability with good calibration (n = 102: 12-month RFS; low risk: 94.2%, intermediate risk: 59.8%, high risk: 42.0%, p < 0.001). The GBRR score is available online at https://ktsahara.shinyapps.io/GBC_earlyrec/ . CONCLUSIONS: A novel online calculator was developed to help clinicians predict the probability of ER after curative-intent resection for GBC. The proposed web-based tool may help in the optimization of surveillance intervals and the counselling of patients about their prognosis.
Authors: Diamantis I Tsilimigras; Kota Sahara; Lu Wu; Dimitrios Moris; Fabio Bagante; Alfredo Guglielmi; Luca Aldrighetti; Matthew Weiss; Todd W Bauer; Sorin Alexandrescu; George A Poultsides; Shishir K Maithel; Hugo P Marques; Guillaume Martel; Carlo Pulitano; Feng Shen; Olivier Soubrane; B Groot Koerkamp; Amika Moro; Kazunari Sasaki; Federico Aucejo; Xu-Feng Zhang; Ryusei Matsuyama; Itaru Endo; Timothy M Pawlik Journal: JAMA Surg Date: 2020-09-01 Impact factor: 14.766
Authors: Yael Berger; Brianne J Sullivan; Natasha L Leigh; Eliahu Y Bekhor; Pooja Dhorajiya; Malary Mani; Deepa R Magge; Da Eun Cha; Umut Sarpel; Spiros P Hiotis; Daniel M Labow; Stephen C Ward; Benjamin J Golas; Noah A Cohen Journal: Ann Surg Oncol Date: 2022-04-18 Impact factor: 5.344
Authors: Andrew J Sinnamon; Anthony C Wood; Megan A Satyadi; Catherine V Levitt; Olivia Hardy; Mintallah Haider; Richard D Kim; Daniel A Anaya; Jason W Denbo Journal: J Gastrointest Oncol Date: 2022-06
Authors: Charlotte M Heidsma; Diamantis I Tsilimigras; Flavio Rocha; Daniel E Abbott; Ryan Fields; George A Poultsides; Clifford S Cho; Alexandra G Lopez-Aguiar; Zaheer Kanji; Alexander V Fisher; Bradley A Krasnick; Kamran Idrees; Eleftherios Makris; Megan Beems; Casper H J van Eijck; Elisabeth J M Nieveen van Dijkum; Shishir K Maithel; Timothy M Pawlik Journal: Cancers (Basel) Date: 2021-05-07 Impact factor: 6.639