Development and Validation of a Prognostic Nomogram Based on the Systemic Immune-Inflammation Index for Resectable Gallbladder Cancer to Predict Survival and Chemotherapy Benefit

ObjectivesTo investigate the prognostic significance of the systemic immune-inflammation index (SII) in patients after radical cholecystectomy for gallbladder cancer (GBC) using overall survival (OS) as the primary outcome measure.MethodsBased on data from a multi-institutional registry of patients with GBC, significant prognostic factors after radical cholecystectomy were identified by multivariate Cox proportional hazards model. A novel staging system was established, visualized as a nomogram. The response to adjuvant chemotherapy was compared between patients in different subgroups according to the novel staging system.ResultsOf the 1072 GBC patients enrolled, 691 was randomly selected in the discovery cohort and 381 in the validation cohort. SII>510 was found to be an independent predictor of OS (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.42-2.54). Carbohydrate antigen 199(CA19-9), tumor differentiation, T stage, N stage, margin status and SII were involved in the nomogram. The nomogram showed a superior prediction compared with models without SII (1-, 3-, 5-year integrated discrimination improvement (IDI):2.4%, 4.1%, 5.4%, P<0.001), and compared to TNM staging system (1-, 3-, 5-year integrated discrimination improvement (IDI):5.9%, 10.4%, 12.2%, P<0.001). The C-index of the nomogram in predicting OS was 0.735 (95% CI 0.683-0.766). The novel staging system based on the nomogram showed good discriminative ability for patients with T2 or T3 staging and with negative lymph nodes after R0 resection. Adjuvant chemotherapy offered significant survival benefits to these patients with poor prognosis.ConclusionsSII was an independent predictor of OS in patients after radical cholecystectomy for GBC. The new staging system identified subgroups of patients with T2 or T3 GBC with negative lymph nodes who benefited from adjuvant chemotherapy.Clinical Trial RegistrationClinicalTrials.gov, identifier (NCT04140552).

EVALUATION OF RADICAL CHOLECYSTECTOMY FOR INCIDENTAL GALLBLADDER CARCINOMA DIAGNOSED AFTER CHOLECYSTECTOMY, SINGLE CENTER EXPERIENCE

Objective: To evaluate the procedure of radical cholecystectomy for incidental gallbladder carcinoma diagnosed after cholecystectomy at a tertiary care teaching hospital of Pakistan. Study Design: Observational study (case series). Place and Duration of Study: Army Liver Transplant Unit, Pak Emirates Military Hospital, Rawalpindi, from Jun2018 to Apr 2019. Methodology: A prospective study was conducted on 11 patients who underwent routine cholecystectomy either open or laparoscopic for a possibly benign condition but were found with a malignancy on histopathology, were included in the study. Detailed assessment regarding all the side effects was done immediately after the procedure, at 48 hours, at time of discharge and two weeks after the procedure was done on all the participants. Results: Out of 11patients included in the final analysis, 06 were male and 05 were female. Mean age of patients put who underwent cholecystectomy and had incidental finding of cancer was 44.23 ± 3.621. Mean duration of hospital stay after the surgery was 5.13 ± 2.175. Most of the patients had well differentiated tumor. Post-operative pain was the commonest complication among the target population followed by biliary complication. Cholecystectomy,Conclusion: Gallbladder carcinoma may be missed on routine clinical screening and radiological modalities.Surgeon should be careful enough and suspect unusual finding of malignancy in routine surgeries. Radicalsurgery of the incidental gallbladder cancer emerged as an effective management modality among the patientsmanaged in our set up during this study period.