Optimizing Outcomes in Gallbladder Cancer: Identifying Predictors of Futile Up-Front Surgery in a Global Multi-center Study.
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Serenari Matteo, Berti Davide, Rivera Belen, Newhook Timothy E, Kristjanpoller Werner, Ruzzenente Andrea, Okuno Masayuki, De Bellis Mario, Panettieri Elena, Ahmad M Usman, Merlo Ignacio, De Rose Agostino Maria, Nishino Hiroto, Sinnamon Andrew J, Donadon Matteo, Hauger Marit S, Guevara Oscar M, Munoz Cesar, Denbo Jason, Chun Yun Shin, Tran Cao Hop S, Sanchez Claria Rodrigo, Tzeng Ching-Wei D, De Aretxabala Xabier, Vivanco Marcelo, Brudvik Kristoffer W, Seo Satoru, Pekolj Juan, Poultsides George A, Anaya Daniel A, Torzilli Guido, Giuliante Felice, Guglielmi Alfredo, Vinuela Eduardo, Vauthey Jean-Nicolas, Cescon Matteo, Vega Eduardo A
Аннотация
METHODS: An international cohort of 788 patients who underwent up-front GBC surgery across 18 centers was analyzed. Futility was defined as recurrence within 5 months or death within 90 days after oncological surgery. A multivariate model was built, and an online calculator was developed to predict the probability of FS.
RESULTS: A total of 107 patients (13.6%) experienced FS, with a median survival of only 6.8 months, compared with 57.4 months for nonfutile cases. The key risk factors identified were the T3-T4 tumor stage (odds ratio [OR] 2.20; 95% confidence interval [CI] 1.30-3.71), lymph node involvement (OR 1.91; 95% CI 1.22-2.98), and multivisceral resection (OR 2.25; 95% CI 1.28-3.94). Incidental GBC diagnoses showed a lower risk of FS (OR 0.41; 95% CI 0.25-0.67). The predictive model had a strong discriminative ability (c-statistic: 0.749). Decision curve analysis demonstrated the superiority of the multivariate model over individual predictors.
CONCLUSIONS: Refining patient selection can reduce futile surgeries in GBC. The predictive model provides a valuable online tool ( https://aicep.website/?cff-form=25 ) to improve decision-making and outcomes by minimizing unnecessary interventions.