European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology · 2025
Development of a novel predictive nomogram to prevent 'futile surgery' in gallbladder cancers: A single center analysis of 1196 resected gallbladder cancers.
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Varty Gurudutt P, Patkar Shraddha, Kazi Mufaddal, Velmurugan Karthik, Padhy Amita Sekhar, Dhanapal Baskaran, Lele Sujat, Kamini Snigdha, Kaderi Abdeali Saif Arif, Pawar Akash, Yadav Subhash, Gudi Shivakumar, Gala Kunal B, Bhargava Prabhat, Ramaswamy Anant, Ostwal Vikas, Goel Mahesh
Аннотация
INTRODUCTION: Advancement in technical expertise, perioperative care and chemotherapeutic regimes have led to stretching the limits of surgery for gallbladder cancers (GBCs). Being an inherently aggressive cancer, do all the patients of GBCs really benefit from a surgical procedure?
METHODS: A total of 1196 cases of gallbladder adenocarcinoma who underwent curative resection from January 2010 to December 2023 were analysed. FS was defined as recurrences or deaths within 6 months of surgery. A multivariate model was built and a preoperative nomogram was created.
RESULTS: A total of 133 (11.1 %) patients underwent a FS with a median overall survival of 8.9 months compared to 88.7 months for patients who underwent a non-futile surgery (p < 0.001). Predefined 'TMH criteria' was used to differentiate 'borderline resectable' GBC (BR-GBC, n = 344, 28.8 %) from upfront resectable GBC (n = 852, 71.2 %) and were subjected to neoadjuvant chemotherapy. Multivariable analysis revealed log CA 19-9 (OR - 1.12, 95 %CI - 1.02-1.22, p = 0.014), borderline resectable GBCs (OR, 1.97, 95 %CI, 1.34-2.88, p = 0.001) and extended/multivisceral resection (OR - 2.01, 95 %CI - 1.13-3.45, p = 0.014) as key preoperative factors predicting a FS. A predictive nomogram was built based on these preoperative factors which had a classification accuracy of 0.888 and a precision of 0.790 on internal validation.
CONCLUSION: In modern day oncology where tumour biology and patient selection assumes prime importance, incorporating our predictive nomogram in preoperative clinical decision-making pathway may guide the clinicians to avoid FS in patients of GBC.
METHODS: A total of 1196 cases of gallbladder adenocarcinoma who underwent curative resection from January 2010 to December 2023 were analysed. FS was defined as recurrences or deaths within 6 months of surgery. A multivariate model was built and a preoperative nomogram was created.
RESULTS: A total of 133 (11.1 %) patients underwent a FS with a median overall survival of 8.9 months compared to 88.7 months for patients who underwent a non-futile surgery (p < 0.001). Predefined 'TMH criteria' was used to differentiate 'borderline resectable' GBC (BR-GBC, n = 344, 28.8 %) from upfront resectable GBC (n = 852, 71.2 %) and were subjected to neoadjuvant chemotherapy. Multivariable analysis revealed log CA 19-9 (OR - 1.12, 95 %CI - 1.02-1.22, p = 0.014), borderline resectable GBCs (OR, 1.97, 95 %CI, 1.34-2.88, p = 0.001) and extended/multivisceral resection (OR - 2.01, 95 %CI - 1.13-3.45, p = 0.014) as key preoperative factors predicting a FS. A predictive nomogram was built based on these preoperative factors which had a classification accuracy of 0.888 and a precision of 0.790 on internal validation.
CONCLUSION: In modern day oncology where tumour biology and patient selection assumes prime importance, incorporating our predictive nomogram in preoperative clinical decision-making pathway may guide the clinicians to avoid FS in patients of GBC.