ASO Author Reflections: Validated Prediction Model of Early Recurrence after Resection for Gallbladder Cancer: Identifyi
- PDF / 222,267 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 94 Downloads / 211 Views
ASO AUTHOR REFLECTIONS
ASO Author Reflections: Validated Prediction Model of Early Recurrence after Resection for Gallbladder Cancer: Identifying a Subset of Patients Who May be Better Served with Neoadjuvant Therapy Kota Sahara, MD1,2, Diamantis I. Tsilimigras, MD2, and Timothy M. Pawlik, MD, MPH, MTS, PhD2 1
Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama, Japan; 2Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, OH
PAST For the majority of patients with incidentally discovered gallbladder cancer (GBC), surgery remains the mainstay of curative-intent therapy. Appropriate oncologic treatment for GBC includes surgical resection, in the form of a nonanatomic resection or formal liver resection to achieve negative surgical margins, as well as an adequate lymphadenectomy.1 Unfortunately, even in the setting of a negative margin resection, postoperative recurrence rates can still be relatively high.2 Although previous studies reported that the timing of recurrence impacts overall survival and post-recurrence treatment, the impact of early recurrence (ER) on outcomes following curative-intent resection for GBC have not been well investigated.3 PRESENT A total of 309 patients who underwent resection for GBC between 2000 and 2018 were identified in the U.S. Extrahepatic Biliary Malignancy Consortium database.4
ASO Author Reflections is a brief invited commentary on the article, ‘‘Defining and Predicting Early Recurrence After Resection for Gallbladder Cancer’’ Ann Surg Oncol. 2020. Ó Society of Surgical Oncology 2020 First Received: 22 August 2020 Accepted: 24 August 2020 T. M. Pawlik, MD, MPH, MTS, PhD e-mail: [email protected]
The optimal cutoff to define ER was determined to be 12 months. A novel Gallbladder Recurrence Risk (GBRR) prediction model was developed to estimate the probability of developing ER based on relevant clinicopathological factors, including preoperative CA19-9 level, type of planned hepatectomy, T category, and histological grade. The online calculation tool classified patients into three distinct risk groups (low-, intermediate-, and high-risk) relative to the possibility of ER (https://ktsahara.shinyapps. io/GBC_earlyrec/). The GBRR score stratified patients accurately relative to 12-month recurrence-free survival (low-risk: 88.4%, intermediate-risk: 77.9%, and high-risk: 37.0%) in the training cohort, as well as in the external validation (low-risk: 94.2%, intermediate-risk: 59.8%, high-risk: 42.0%) (both log-rank p \ 0.001). Approximately 1 in 6 patients undergoing resection for GBC were categorized in the high-risk group for ER with only 40% of these individuals being recurrence-free at 12 months following resection. FUTURE Data from the current study emphasize that ER was common after resection for GBC. Patients at high risk of recurrence within 12 months of surgery could be identified by using a validated online ER calculator. Similar t
Data Loading...
