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Background <p>Gallbladder cancer (GBC) has a poor prognosis, particularly in advanced stages, with surgery often offering limited survival benefit. This study aimed to identify risk factors for futile surgery (FS), defined as procedures followed by early recurrence or death.</p> Methods <p>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.</p> Results <p>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.</p> Conclusions <p>Refining patient selection can reduce futile surgeries in GBC. The predictive model provides a valuable online tool (<a href="https://aicep.website/?cff-form=25">https://aicep.website/?cff-form=25</a>) to improve decision-making and outcomes by minimizing unnecessary interventions.</p>

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Optimizing Outcomes in Gallbladder Cancer: Identifying Predictors of Futile Up-Front Surgery in a Global Multi-center Study

  • 期刊论文

  • 发表日期：

    2025年3月6日

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  • Matteo Serenari,
  • Davide Berti,
  • Belen Rivera,
  • Timothy E. Newhook,
  • Werner Kristjanpoller,
  • Andrea Ruzzenente,
  • Masayuki Okuno,
  • Mario De Bellis,
  • Elena Panettieri,
  • M. Usman Ahmad,
  • Ignacio Merlo,
  • Agostino Maria De Rose,
  • Hiroto Nishino,
  • Andrew J. Sinnamon,
  • Matteo Donadon,
  • Marit S. Hauger,
  • Oscar M. Guevara,
  • Cesar Munoz,
  • Jason Denbo,
  • Yun Shin Chun,
  • Hop S. Tran Cao,
  • Rodrigo Sanchez Claria,
  • Ching-Wei D. Tzeng,
  • Xabier De Aretxabala,
  • Marcelo Vivanco,
  • Kristoffer W. Brudvik,
  • Satoru Seo,
  • Juan Pekolj,
  • George A. Poultsides,
  • Daniel A. Anaya,
  • Guido Torzilli,
  • Felice Giuliante,
  • Alfredo Guglielmi,
  • Eduardo Vinuela,
  • Jean-Nicolas Vauthey,
  • Matteo Cescon,
  • Eduardo A. Vega

摘要

Background

Gallbladder cancer (GBC) has a poor prognosis, particularly in advanced stages, with surgery often offering limited survival benefit. This study aimed to identify risk factors for futile surgery (FS), defined as procedures followed by early recurrence or death.

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.