Effect of lymphadenectomy on the prognosis for N0 gallbladder carcinoma patients: A study based on SEER database

New trends in diagnosis and management of gallbladder carcinoma

Gallbladder (GB) carcinoma, although relatively rare, is the most common biliary tree cholangiocarcinoma with aggressiveness and poor prognosis. It is closely associated with cholelithiasis and long-standing large (> 3 cm) gallstones in up to 90% of cases. The other main predisposing factors for GB carcinoma include molecular factors such as mutated genes, GB wall calcification (porcelain) or mainly mucosal microcalcifications, and GB polyps ≥ 1 cm in size. Diagnosis is made by ultrasound, computed tomography (CT), and, more precisely, magnetic resonance imaging (MRI). Preoperative staging is of great importance in decision-making regarding therapeutic management. Preoperative staging is based on MRI findings, the leading technique for liver metastasis imaging, enhanced three-phase CT angiography, or magnetic resonance angiography for major vessel assessment. It is also necessary to use positron emission tomography (PET)-CT or 18F-FDG PET-MRI to more accurately detect metastases and any other occult deposits with active metabolic uptake. Staging laparoscopy may detect dissemination not otherwise found in 20%-28.6% of cases. Multimodality treatment is needed, including surgical resection, targeted therapy by biological agents according to molecular testing gene mapping, chemotherapy, radiation therapy, and immunotherapy. It is of great importance to understand the updated guidelines and current treatment options. The extent of surgical intervention depends on the disease stage, ranging from simple cholecystectomy (T1a) to extended resections and including extended cholecystectomy (T1b), with wide lymph node resection in every case or IV-V segmentectomy (T2), hepatic trisegmentectomy or major hepatectomy accompanied by hepaticojejunostomy Roux-Y, and adjacent organ resection if necessary (T3). Laparoscopic or robotic surgery shows fewer postoperative complications and equivalent oncological outcomes when compared to open surgery, but much attention must be paid to avoiding injuries. In addition to surgery, novel targeted treatment along with immunotherapy and recent improvements in radiotherapy and chemotherapy (neoadjuvant-adjuvant capecitabine, cisplatin, gemcitabine) have yielded promising results even in inoperable cases calling for palliation (T4). Thus, individualized treatment must be applied.

Development and validation of prognostic nomograms in patients with gallbladder mucinous adenocarcinoma: A population-based study

Background

Gallbladder mucinous adenocarcinoma (GBMAC) is an uncommon malignant gallbladder tumor. There are few studies on its prognosis, with the majority consisting of small series or individual cases. We sought to develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in GBMAC patients.

Methods

The clinicopathological data of GBMAC patients from 1975 to 2019 was extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and all patients were randomly divided into a training cohort (70%) and a validation cohort (30%). Using multivariate Cox regression analyses based on Akaike information criterion (AIC), prognostic and important variables for GBMAC were determined. On the basis of these factors, nomograms were developed to predict the 1-, 3-, and 5-year OS and CSS rates of patients with GBMAC. Multiple parameters, including the area under the subject operating characteristic curve (AUC), the calibration plots, and the decision curve analysis (DCA), were then used to evaluate the accuracy of nomograms.

Results

Following exclusion, a total of 707 GBMAC patients were enrolled, and the training cohort (490, 70%) and validation cohort (217, 30%) were randomly assigned. Grade, surgery, radiation, and SEER stage were predictive factors for patients with GBMAC, as indicated by univariate and multivariate Cox regression analyses based on AIC. We created nomograms for predicting OS and CSS in GBMAC using the four factors. The calibration curves and area under the curves (AUCs) indicated that our nomograms have a moderate degree of predictive accuracy and capability. The results of the DCA revealed that the nomogram has a high predictive value.

Conclusion

We established the first nomograms for predicting 1-, 3-, and 5-year OS and CSS in GBMAC patients, thereby contributing to the prognostication of patients and clinical management.

Effect of lymphadenectomy on the prognosis for N0 gallbladder carcinoma patients: A study based on SEER database

Background

It remains unclear whether lymph node dissection is necessary for patients with N0 gallbladder carcinoma (GBC). The objective of this study was to evaluate the effect of lymphadenectomy on the prognosis for N0 GBC patients. The secondary objective was to establish a prognostic model of survival for N0 GBC patients being founded on the large samples.

Methods

Patient data were obtained from the database named SEER (Surveillance, Epidemiology, and End Results database) between 2010 and 2014. Analyses of Kaplan–Meier survival and multivariate Cox regression were performed in subgroups based on regional lymph nodes removal (LNR) to calculate the excess risk of cause‐specific death. A prognosis nomogram was constructed build on the results of a multivariate analysis to predict the specific survival time (CSS) rates of N0 GBC patients.

Result

A total of 1406 N0 GBC patients were included in this research. The majority of N0 GBC patients undergoing cancer‐directed surgery did not undergo LNR (64.5%). The results showed that LNR can improve the survival of N0 GBC patients, including those at the T1a and T1b stages, and a wider range of lymph node dissection (LNR2) compared to LNR1 was more conducive to the prognosis. Furthermore, multivariate regression analysis showed that LNR was an independent favorable prognostic factor of N0 GBC. Finally, a nomogram was constructed to accurately predict the prognosis of N0 gallbladder cancer patients.

Conclusion

This study demonstrated a significant survival benefit for extended lymph nodes removed in N0 GBC patients. These results recommend that an extended lymph node dissection strategy is needed for N0 GBC patients.