Indications for extrahepatic bile duct resection due to perineural invasion in patients with gallbladder cancer

Maruyama, Suguru; Kawaida, Hiromichi; Hosomura, Naohiro; Amemiya, Hidetake; Saito, Ryo; Shimizu, Hiroki; Furuya, Shinichi; Akaike, Hidenori; Kawaguchi, Yoshihiko; Sudo, Makoto; Inoue, Satoshi; Kono, Hiroshi; Ichikawa, Daisuke

doi:10.1186/s12957-019-1735-0

Cited by 16 publications

(16 citation statements)

References 23 publications

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“…Some studies had reported that perineural invasion was significantly related to residual disease in incidental gallbladder carcinoma. Other researches also indicated that perineural invasion was associated with poor prognosis of GBC patients after surgical resection [ 15 , 16 ]. Perineural invasion was almost not observed in patients with stage T1 cancer, while it was detected rarely in distal-type tumors, which would develop various types of recurrences [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Other researches also indicated that perineural invasion was associated with poor prognosis of GBC patients after surgical resection [ 15 , 16 ]. Perineural invasion was almost not observed in patients with stage T1 cancer, while it was detected rarely in distal-type tumors, which would develop various types of recurrences [ 15 ]. A current study indicated that an increasing affinity for nerve of tumor cells may be caused by a reciprocal interaction between the cancer cells and the microenvironment of the host nerve [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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A Novel Prognostic Nomogram for Gallbladder Cancer after Surgical Resection: A Single-Center Experience

Dong

et al. 2021

Journal of Oncology

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Background. Gallbladder cancer (GBC), which accounts for more than 80% of biliary tract malignancies, has a poor prognosis with an overall 5-year survival less than 10%. The study aimed to identify risk factors and develop a predictive model for GBC following surgical resection. Methods. 98 GBC patients who underwent surgical resection from Guangdong Provincial People’s Hospital were enrolled in the study. Cox-regression analysis was performed to identify significant prognostic factors. A nomogram was constructed and Harrell’s concordance index, calibration plot, and decision cure analysis were used to evaluate the discrimination and calibration of the nomogram. Results. Liver resection, tumor size, perineural invasion, surgical margin, and liver invasion were identified as independent risk factors for overall survival (OS) in GBC patients who underwent surgical resection. Based on the selected risk factors, a novel nomogram was constructed. The C-index of the nomogram was 0.777, which was higher than the American Joint Committee on Cancer (AJCC) staging system (0.724) and Nevin staging system (0.659). Decision cure analysis revealed that the nomogram had a better net benefit and the calibration curves for the 1-, 3-, and 5-year survival probabilities were also well matched with the actual survival rates. Lastly, high-risk GBC were stratified based on the scores of the nomogram and we found high-risk GBC were associated with both worse OS and disease-free survival (DFS). Conclusion. We developed a nomogram showing a better predictive capacity for patients’ survival of resected GBC than the AJCC staging systems. The established model may help to stratify high-risk GBC and facilitate decision-making in the clinic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A Novel Prognostic Nomogram for Gallbladder Cancer after Surgical Resection: A Single-Center Experience

Dong

et al. 2021

Journal of Oncology

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“…Given the differences among survival rates beyond the T-stage, the identification of patients at high risk of recurrence and the implementation of postoperative surveillance strategies are essential for improving patient outcome, especially for incidental GBC. Some studies have identified tumor grade, lymphovascular invasion, and perineural invasion as independent prognostic factors that also correlate with the presence of residual and/or disseminated disease at the time of re-resection [83][84][85][86][87][88]. Recently, the U.S. Extrahepatic Biliary Malignancy Consortium (USEBMC) developed a Gallbladder Cancer Predictive Risk Score (GBRS) based on four pathology-derived risk factors: T-stage, tumor grade, lymphovascular invasion, and perineural invasion.…”

Section: Pathological Prognostic Markers For Early and Advanced Gallbmentioning

confidence: 99%

Current and New Biomarkers for Early Detection, Prognostic Stratification, and Management of Gallbladder Cancer Patients

García

Lamarca

Díaz

et al. 2020

Cancers

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Gallbladder cancer (GBC) is an aggressive disease that shows evident geographic variation and is characterized by a poor prognosis, mainly due to the late diagnosis and ineffective treatment. Genetic variants associated with GBC susceptibility, including polymorphisms within the toll-like receptors TLR2 and TLR4, the cytochrome P450 1A1 (CYP1A1), and the ATP-binding cassette (ABC) transporter ABCG8 genes, represent promising biomarkers for the stratification of patients at higher risk of GBC; thus, showing potential to prioritize cholecystectomy, particularly considering that early diagnosis is difficult due to the absence of specific signs and symptoms. Similarly, our better understanding of the gallbladder carcinogenic processes has led to identify several cellular and molecular events that may influence patient management, including HER2 aberrations, high tumor mutational burden, microsatellite instability, among others. Despite these reports on interesting and promising markers for risk assessment, diagnosis, and prognosis; there is an unmet need for reliable and validated biomarkers that can improve the management of GBC patients and support clinical decision-making. This review article examines the most potentially significant biomarkers of susceptibility, diagnosis, prognosis, and therapy selection for GBC patients, highlighting the need to find and validate existing and new molecular biomarkers to improve patient outcomes.

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“…T stage is an important determinant of final outcome of GBC patients[ 25 , 26 ]. Increasing T stage is also associated with a higher probability of lymph nodal involvement and PNI[ 4 , 27 ]. Higher T stage (pT3/T4) was the only factor which negatively impacted both OS and DFS in our study.…”

Section: Discussionmentioning

confidence: 99%

Multimodality management of gallbladder cancer can lead to a better outcome: Experience from a tertiary care oncology centre in North India

Goel¹,

Aggarwal²,

Iqbal³

et al. 2021

WJG

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BACKGROUND Surgical resection is a treatment of choice for gallbladder cancer (GBC) patients but only 10% of patients have a resectable disease at presentation. Even after surgical resection, overall survival (OS) has been poor due to high rates of recurrence. Combination of surgery and systemic therapy can improve outcomes in this aggressive disease. AIM To summarize our single-center experience with multimodality management of resectable GBC patients. METHODS Data of all patients undergoing surgery for suspected GBC from January 2012 to December 2018 was retrieved from a prospectively maintained electronic database. Information extracted included demographics, operative and perioperative details, histopathology, neoadjuvant/adjuvant therapy, follow-up, and recurrence. To know the factors associated with recurrence and OS, univariate and multivariate analysis was done using log rank test and cox proportional hazard analysis for categorical and continuous variables, respectively. Multivariate analysis was done using multiple regression analysis. RESULTS Of 274 patients with GBC taken up for surgical resection, 172 (62.7%) were female and the median age was 56 years. On exploration, 102 patients were found to have a metastatic or unresectable disease (distant metastasis in 66 and locally unresectable in 34). Of 172 patients who finally underwent surgery, 93 (54%) underwent wedge resection followed by anatomical segment IVb/V resection in 66 (38.4%) and modified extended right hepatectomy in 12 (7%) patients. The postoperative mortality at 90 d was 4.6%. During a median follow-up period of 20 mo, 71 (41.2%) patients developed recurrence. Estimated 1-, 3-, and 5-years OS rates were 86.5%, 56%, and 43.5%, respectively. Estimated 1- and 3-year disease free survival (DFS) rates were 75% and 49.2%, respectively. On multivariate analysis, inferior OS was seen with pT3/T4 tumor ( P = 0.0001), perineural invasion ( P = 0.0096), and R+ resection ( P = 0.0125). However, only pT3/T4 tumors were associated with a poor DFS ( P < 0.0001). CONCLUSION Multimodality treatment significantly improves the 5-year survival rate of patients with GBC up to 43%. R+ resection, higher T stage, and perineural invasion adversely affect the outcome and should be considered for systemic therapy in addition to surgery to optimize the outcomes. Multimodality treatment of GBC has potential to improve the survival of GBC patients.

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Indications for extrahepatic bile duct resection due to perineural invasion in patients with gallbladder cancer

Cited by 16 publications

References 23 publications

A Novel Prognostic Nomogram for Gallbladder Cancer after Surgical Resection: A Single-Center Experience

A Novel Prognostic Nomogram for Gallbladder Cancer after Surgical Resection: A Single-Center Experience

Current and New Biomarkers for Early Detection, Prognostic Stratification, and Management of Gallbladder Cancer Patients

Multimodality management of gallbladder cancer can lead to a better outcome: Experience from a tertiary care oncology centre in North India

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