Differential and prognostic MRI features of gallbladder neuroendocrine tumors and adenocarcinomas

Preoperative MRI-based nomogram to predict survival after curative resection in patients with gallbladder cancer: a retrospective multicenter analysis

PURPOSE

To use preoperative MRI data to construct a nomogram to predict survival in patients who have undergone R0 resection for gallbladder cancer.

METHODS

The present retrospective study included 143 patients (M:F, 76:67; 67.15 years) with gallbladder cancer who underwent preoperative MRI and subsequent R0 resection between 2013 and 2021 at two tertiary institutions. Clinical and radiological features were analyzed using univariate and multivariate Cox regression analysis to identify independent prognostic factors. Based on the multivariate analysis, we developed an MRI-based nomogram for determining prognoses after curative resections of gallbladder cancer. We also obtained calibration curves for 1-,3-, and 5-year survival probabilities.

RESULTS

The multivariate model consisted of the following independent predictors of poor overall survival (OS), which were used for constructing the nomogram: age (years; hazard ratio [HR] = 1.04; 95% confidence interval [CI], 1.04-1.07; p = 0.033); tumor size (cm; HR = 1.40; 95% CI, 1.09-1.79; p = 0.008); bile duct invasion (HR = 3.54; 95% CI, 1.66-7.58; p = 0.001); regional lymph node metastasis (HR = 2.47; 95% CI, 1.10-5.57; p = 0.029); and hepatic artery invasion (HR = 2.66; 95% CI, 1.04-6.83; p = 0.042). The nomogram showed good probabilities of survival on the calibration curves, and the concordance index of the model for predicting overall survival (OS) was 0.779.

CONCLUSION

Preoperative MRI findings could be used to determine the prognosis of gallbladder cancer, and the MRI-based nomogram accurately predicted OS in patients with gallbladder cancer who underwent curative resection.

Comparative prognosis and risk assessment in gallbladder neuroendocrine neoplasms versus adenocarcinomas

Background

Gallbladder neuroendocrine neoplasms (GB-NENs) are a rare malignant disease, with most cases diagnosed at advanced stages, often resulting in poor prognosis. However, studies regarding the prognosis of this condition and its comparison with gallbladder adenocarcinomas (GB-ADCs) have yet to yield convincing conclusions.

Methods

We extracted cases of GB-NENs and GB-ADCs from the Surveillance, Epidemiology, and End Results (SEER) database in the United States. Firstly, we corrected differences in clinical characteristics between the two groups using propensity score matching (PSM). Subsequently, we visualized and compared the survival outcomes of the two groups using the Kaplan-Meier method. Next, we employed the least absolute shrinkage and selection operator (LASSO) regression and Cox regression to identify prognostic factors for GB-NENs and constructed two nomograms for predicting prognosis. These nomograms were validated with an internal validation dataset from the SEER database and an external validation dataset from a hospital. Finally, we categorized patients into high-risk and low-risk groups based on their overall survival (OS) scores.

Results

A total of 7,105 patients were enrolled in the study, comprising 287 GB-NENs patients and, 6,818 GB-ADCs patients. There were substantial differences in clinical characteristics between patients, and GB-NENs exhibited a significantly better prognosis. Even after balancing these differences using PSM, the superior prognosis of GB-NENs remained evident. Independent prognostic factors selected through LASSO and Cox regression were age, histology type, first primary malignancy, tumor size, and surgery. Two nomograms for prognosis were developed based on these factors, and their performance was verified from three perspectives: discrimination, calibration, and clinical applicability using training, internal validation, and external validation datasets, all of which exhibited excellent validation results. Using a cutoff value of 166.5 for the OS nomogram score, patient mortality risk can be identified effectively.

Conclusion

Patients with GB-NENs have a better overall prognosis compared to those with GB-ADCs. Nomograms for GB-NENs prognosis have been effectively established and validated, making them a valuable tool for assessing the risk of mortality in clinical practice.

Imaging manifestations and pathological features of neuroendocrine carcinoma of the gallbladder

BACKGROUND

Neuroendocrine carcinoma of the gallbladder is a rare clinical condition that is mostly described as case reports in the domestic and foreign literature, and its clinical features and imaging manifestations are rarely summarized.

AIM

To explore the imaging and pathological manifestations of neuroendocrine carcinoma of the gallbladder to improve the understanding of the disease.

METHODS

A retrospective analysis was performed on the clinical data as well as imaging and pathological manifestations of eight cases of neuroendocrine carcinoma of the gallbladder.

RESULTS

The patients ranged in age from 35 to 66 years, with a mean age of 55.5 years. There were seven females and one male. The maximum diameter of the tumor was about 0.7 cm-11.6 cm. Computed tomography examination showed soft tissue density in five cases and slightly low density lesion in one. Mild to moderate uneven enhancement was observed, with thickening and enhancement of the gallbladder wall in three cases. Magnetic resonance imaging examination was performed in all eight cases, which revealed slightly long/long T1 and equal/long T2 signals, uneven continuous enhancement, and obvious enhancement in the arterial phase in two cases. There were porta hepatis and duodenal metastases with abdominal and retroperitoneal lymph node metas-tases in five cases, liver involvement in two, hilar bile duct compression in four, common bile duct invasion in two, and complication with pancreatic metastasis in one. Immunohistochemical staining showed that all the eight cases were positive for chromogranin and synaptophysin, five positive for cytokeratins and CD56, and four positive for neuron-specific enolase. Six patients had a Ki-67 index > 20% (> 70% in 4 cases), one had a Ki-67 index of 9%, and one had a Ki-67 index of 12%.

CONCLUSION

The imaging manifestations of gallbladder neuroendocrine carcinoma are irregular soft tissue masses in the base of the gallbladder, accompanied by diffuse thickening of the gallbladder wall and complete mucosal layer. The malignancy of the tumor is high, and metastasis along the lymphatic vessels and blood channels can occur in the early stage. Although the imaging manifestations and pathological features are valuable for early diagnosis and differential diagnosis, the final diagnosis still relies on pathological examination.

Robotic versus open extended cholecystectomy for T1a–T3 gallbladder cancer: A matched comparison

Background

The feasibility and safety of robotic extended cholecystectomy (REC) are still uncertain. This study was performed to compare the short- and long-term outcomes of REC with those of open extended cholecystectomy (OEC) for T1a–T3 gallbladder cancer.

Methods

From January 2015 to April 2022, 28 patients underwent REC in our center. To minimize any confounding factors, a 1:2 propensity score-matching analysis was conducted based on the patients’ demographics, liver function indicators, T stage, and symptoms. The data regarding demographics, perioperative outcomes, and long-term oncologic outcomes were reviewed.

Results

The visual analogue scale score was significantly lower in the REC than OEC group immediately postoperatively (3.68 ± 2.09 vs. 4.73 ± 1.85, P = 0.008), on postoperative day 1 (2.96 ± 1.75 vs. 3.69 ± 1.41, P = 0.023), and on postoperative day 2 (2.36 ± 1.55 vs. 2.92 ± 1.21, P = 0.031). In addition, the REC group exhibited a shorter time to first ambulation (P = 0.043), a shorter time to drainage tube removal (P = 0.038), and a shorter postoperative stay (P = 0.037), but hospital costs were significantly higher in the REC group (P < 0.001). However, no statistically significant difference was found in the operation time (P = 0.134), intraoperative blood loss (P = 0.467), or incidence of postoperative morbidity (P = 0.227) or mortality (P = 0.289) between the REC and OEC groups. In regard to long-term outcomes, the 3-year disease-free survival rate was comparable between the OEC and REC groups (43.1% vs. 57.2%, P = 0.684), as was the 3-year overall survival rate (62.8% vs. 75.0%, P = 0.619).

Conclusion

REC can be an effective and safe alternative to OEC for selected patients with T1a–T3 gallbladder cancer with respect to short- and long-term outcomes.

Gallbladder Neuroendocrine Tumors: Is There a Need for a Specific Approach?

Neuroendocrine tumors (NETs) of the gallbladder or the biliary tree are rare. Most of the current guidelines and protocols are derived from the experience of managing lung small cell neuroendocrine carcinoma or gastrointestinal NETs. But, the overall outcome of gallbladder NETs (GB-NETs) seems worse than similarly staged lung NETs and adenocarcinoma of the gallbladder. This may be due to its rarity and lack of literature for a focused approach toward its treatment. Hence, the need for a specifically designed approach might help improve results of treatment for these rare tumors. We share our experience of 2 patients with GB-NETs and their 5-year outcome.

Apparent Diffusion Coefficient Values for Neuroendocrine Liver Metastases

RATIONALE AND OBJECTIVES

We aimed to investigate whether there are any differences in apparent diffusion coefficient (ADC) values obtained from liver metastases due to gastroenteropancreatic neuroendocrine tumors (GEP-NET) and adenocarcinomas.

MATERIALS AND METHODS

We included 54 patients with 167 liver metastases due to gastroenteropancreatic tumors. We divided the patients into two groups as liver metastases due to GEP-NETs (seven patients with 51 lesions, mean age: 48) and adenocarcinomas (47 patients with 116 lesions, mean age: 61.2). We used the independent samples t-test to compare the ADC and ADC_mean values of the two groups and performed a receiver-operating characteristic analysis.

RESULTS

ADC and ADC_mean values were significantly lower in the GEP-NET group compared with the adenocarcinoma group. Receiver-operating characteristic curve analysis showed a significant difference for ADC and ADC_mean values, and area under the curve values were 0.733 and 0.790, respectively. The cut-off values were 933x10^-6 mm²/s for ADC and 801x10^-6 mm²/s for ADC_mean. Diagnostic accuracies of ADC (Sensitivity = 80.2, Specificity = 64.7, PPV = 83.8, NPV = 58.9) and ADC_mean (Sensitivity = 63.8, Specificity = 82.4, PPV = 89.2, NPV = 50) were calculated in differentiating adenocarcinoma metastases from GEP-NET metastases.

CONCLUSION

The lower ADC and ADC_mean values of liver metastases suggest GEP-NET rather than adenocarcinomas. ADC and ADC_mean values obtained from liver metastases may be used to differentiate NETs from adenocarcinomas.

Update in clinical management for gallbladder neuroendocrine carcinoma

BACKGROUND

Gallbladder neuroendocrine carcinoma (GB-NEC) is rare and there are few reports at present. We sought to review the current knowledge of GB-NEC and provide recommendations for clinical management.

METHODS

A systemic literature research was conducted in the websites of Pubmed, Medline, Web of Science, CNKI, Wanfang Data using the keywords including gallbladder combined with neuroendocrine carcinoma or neuroendocrine tumor or neuroendocrine neoplasm. Two reviewers independently screened the articles by reading the title, abstract and full-text.

RESULTS

In computed tomography (CT) and magnetic resonance imaging (MRI) examination, a well-defined margin, gallbladder replacing type with larger hepatic and lymphatic metastases could be helpful for differential diagnosis of GB-NEC and gallbladder adenocarcinoma (GB-ADC). Older age, unmarried status, large tumor size (>5 cm), positive margins, and distant Surveillance, Epidemiology and End result (SEER) stage are independently associated with poor survival. Surgical resection remains as the preferred and primary treatment. The potential survival benefit of lymphadenectomy for patients remains controversial. Platinum-based postoperative adjuvant chemotherapy may improve the survival. The efficacy of other treatments including immunotherapy, targeted therapy and somatostatin analogue needs further investigation.

CONCLUSION

Typical imaging features could be helpful for preoperative diagnosis. Age, margin status, tumor size, marital status, histopathologic subtype and SEER stage may be independent predictors for the survival. Remarkable advances regarding the treatment for GB-NEC have been achieved in recent years. Further studies are needed to investigate the survival benefit of lymphadenectomy for patients with GB-NEC.

Gallbladder neuroendocrine carcinoma: A single center experience

Gallbladder neuroendocrine carcinoma (GB-NEC) is a group of rare and heterogeneous neoplasms and there are few reports at present.We analyzed the clinical and pathological features of 7 patients with GB-NEC who were admitted to Zhejiang Provincial People's Hospital from January 2011 to October 2019.The median age of 7 patients was 58 years with male to female ratio of 1:2.5. Right upper quadrant discomfort was the main complaint and no patients presented carcinoid syndrome-related symptoms. In contrast-enhanced computed tomography (CT) examination, 5 of 6 patients showed well-defined margin and continuous thin line-like contrast enhancement on the mucosa. Among the patients with liver metastases before surgery, 66.7% of patients were cancer antigen 125 (CA-125) positive, and among the patients presented with liver metastases during follow-up period, all patients were CA-125 positive. All patients with elevated CA-125 did not have ascites, ovarian carcinoma, peritoneal carcinoma, and endometrial carcinoma. According to postoperative pathological report, 1 patient was stage IIIA, and the other 6 patients were stage IVB. Six patients underwent surgery, and 1 patient just underwent liver biopsy. Two patients underwent laparoscopic radical cholecystectomy, and neither of them encountered serious complications after surgery with the overall survival time of 4.6 and 16.8 months, respectively. Compared with the patients without chemotherapy, 3 patients postoperatively treated with chemotherapy lived longer. The median survival of all 7 patients was 4.6 months and the 1-, 2-year survival rates were 14.29%, 0%.Surgical resection, including laparoscopic radical cholecystectomy, is feasible for the treatment of advanced GB-NEC in selected patients and has the advantages of prolonging survival in combination with chemotherapy. The elevation of CA-125 can be utilized as an important predictor of poor prognosis, while more investigations are necessary to confirm it.

Neuroendocrine tumors of the gallbladder

A gallbladder neuroendocrine neoplasm (GB-NEN) is a unique heterogeneous neoplasm, originating from neuroendocrine cells and able to secrete peptides as its neurotransmitter. Among all the neuroendocrine tumors (NETs), the GB-NEN prevalence is 0.5%, which accounts for ~2.1% of all gallbladder tumors. The current study aimed to present an up-to-date review of the clinical features, diagnosis and treatment of NETs of the gallbladder. A systematic literature search was performed in order to identify all relevant studies published. Thus far, the etiology and pathogenesis of GB-NEN remains unclear. Moreover, an ambiguous clinical manifestation exists as observed during laboratory examinations. As GB-NEN is a rare gallbladder lesion and is seldom seen in clinical practice, there is a limited availability of review reports, and it is therefore often considered only as a case study. It is difficult to distinguish GB-NEN from other gallbladder diseases using imaging diagnostic techniques. Although chemotherapy treatment provides prolonged progression-free survival, surgery is considered the best option. Thus, to overcome the inherent risks or shortfalls of traditional surgery; early detection, diagnosis and treatment of GB-NEN are required to improve patient longevity.