The oncologic burden of residual disease in incidental gallbladder cancer: An elastic net regression model to profile high-risk features.
Eur J Surg Oncol
; 50(7): 108397, 2024 Jul.
Article
de En
| MEDLINE
| ID: mdl-38815335
ABSTRACT
INTRODUCTION:
Incidental Gallbladder Cancer (IGBC) following cholecystectomy constitutes a significant portion of gallbladder cancer diagnoses. Re-exploration is advocated to optimize disease clearance and enhance survival rates. The consistent association of residual disease (RD) with inferior oncologic outcomes prompts a critical examination of re-resection's role as a modifying factor in the natural history of IGBC.METHODS:
All patients diagnosed with gallbladder cancer between 2012 and 2022 were included. An elastic net regularized regression model was employed to profile high-risk predictors of RD within the IGBC group. Survival outcomes were assessed based on resection margins and RD.RESULTS:
Among the 181 patients undergoing re-exploration for IGBC, 133 (73.5 %) harbored RD, while 48 (26.5 %) showed no evidence. The elastic net model, utilizing a selected λ = 0.029, identified six coefficients associated with the risk of RD aspiration from cholecystectomy (0.141), hepatic tumor origin (1.852), time to re-exploration >8 weeks (1.879), positive margin status (2.575), higher T stage (1.473), and poorly differentiated tumors (2.241). Furthermore, the study revealed a median overall survival of 44 months (CI 38-60) for IGBC patients with no evidence of RD, compared to 31 months (23-42) for those with RD (p < 0.001).CONCLUSION:
Re-resection revealed a high incidence of RD (73.5 %), significantly correlating with poorer survival outcomes. The preoperative identification of high-risk features provides a reliable biological disease profile. This aids in strategic preselection of patients who may benefit from re-resection, underscoring the need to consolidate outcomes with tailored chemotherapy for those with unfavorable characteristics.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Cholécystectomie
/
Maladie résiduelle
/
Résultats fortuits
/
Marges d'exérèse
/
Tumeurs de la vésicule biliaire
Limites:
Aged
/
Female
/
Humans
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Male
/
Middle aged
Langue:
En
Journal:
Eur J Surg Oncol
Sujet du journal:
NEOPLASIAS
Année:
2024
Type de document:
Article
Pays d'affiliation:
Italie