159229-173

A novel pathology-based preoperative risk score to predict distant and locoregional residual disease and survival for incidentally discovered gallbladder cancer: A 10-institution study from the US Extrahepatic Biliary Malignancy Consortium.

Category: 
Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract
Session Type and Session Title: 
Poster Session B: Cancers of the Pancreas, Small Bowel, and Hepatobiliary Tract
Abstract Number: 

202

Poster Board Number: 
Poster Session B Board #A12
Citation: 
J Clin Oncol 34, 2016 (suppl 4S; abstr 202)
Author(s): 
Cecilia Grace Ethun, Lauren McLendon Postlewait, Timothy M. Pawlik, Stefan Buettner, George A. Poultsides, Thuy Tran, Kamran Idrees, Chelsea A Isom, Ryan C. Fields, Linda Jin, Sharon M. Weber, Ahmed I. Salem, Charles Raben Scoggins, Perry Shen, Harveshp Mogal, Carl Richard Schmidt, Eliza W Beal, Ioannis Hatzaras, Rivfka Shenoy, Shishir Kumar Maithel; Division of Surgical Oncology, Department of Surgery, Winship Cancer Institute of Emory University, Atlanta, GA; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Surgery, Stanford University Medical Center, Stanford, CA; Division of Surgical Oncology, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Surgery, Washington University School of Medicine, St. Louis, MO; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI; Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY; Department of Surgery, Wake Forest University, Winston-Salem, NC; Division of Surgical Oncology, Department of Surgery, Wake Forest University School of Medicine, Winston-Salem, NC; Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH; Department of Surgery, New York University, New York, NY; Winship Cancer Institute of Emory University, Atlanta, GA

Abstract Disclosures

Abstract: 

Background: T-stage alone is currently used to guide treatment for incidentally discovered gallbladder cancer. We aimed to develop a more robust predictive model for discovering distant or locoregional residual disease at the time of re-resection. Methods: All patients with incidentally discovered gallbladder cancer who underwent re-resection at 10 institutions from 2000-2015 were included. We utilized routine pathology data from initial cholecystectomy to create a gallbladder cancer predictive risk score (GBRS) for finding distant or locoregional residual disease at re-resection and predicting overall survival (OS). Results: Of 449pts with gallbladder cancer, 262 (58%) were incidentally discovered and underwent attempted re-resection. Advanced T-stage, grade, and lymphovascular (LVI) and perineural (PNI) invasion were all associated with increased rates of distant and locoregional residual disease, 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 were added for a total GBRS score ranging from 3-10. The scores were then separated into 3 risk groups (Low: 3-4; Intermediate: 5-7; High: 8-10). Each progressive GBRS group was associated with an increased risk of finding distant and isolated locoregional residual disease at the time of re-resection, and was associated with reduced median OS (Table). Conclusions: By accounting for pathologic variations within each T-stage, this novel predictive risk-score redistributes T1b, T2, and T3 disease across separate risk-groups and more accurately identifies patients with incidentally discovered gallbladder cancer at risk for distant and locoregional residual disease, and decreased long-term survival. This score may help to better optimize treatment strategy for patients with incidentally discovered gallbladder cancer.

Risk Group
P-value
LowIntermediateHigh
Distant Disease0%3%24%0.011
Locoregional Disease0%32%61%0.018
Overall Survival (mos)MNR6716< 0.001