Preoperative CT findings for prediction of resectability in patients with gallbladder cancer

Seo Youn Choi, Jung Hoon Kim, Hyun Jeong Park, Joon Koo Han

Research output: Contribution to journalArticle

Abstract

Objectives: To predict residual tumor (R) classification in patients with a surgery for gallbladder (GB) cancer, using preoperative CT. Methods: One hundred seventy-three patients with GB cancer who underwent CT and subsequent surgery were included. Two radiologists assessed CT findings, including tumor morphology, location, T stage, adjacent organ invasion, hepatic artery (HA) invasion, portal vein invasion, lymph node metastasis, metastasis, resectability, gallstone, and combined cholecystitis. The R classification was categorized as no residual tumor (R0) and residual tumor (R1 or R2). We analyzed the correlation between CT findings and R classification. We also followed up the patients as long as five years and analyzed the relationship between the R classification and the overall survival (OS). Results: There were 134 patients with R0 and 39 patients with R1/R2. On multivariable analysis, liver invasion (Exp(B) = 3.19, p = 0.010), bile duct invasion (Exp(B) = 3.69, p = 0.031), and HA invasion (Exp(B) = 3.74, p = 0.039) were independent, significant predictors for residual tumor. When two of these three criteria were combined, the accuracy for predicting a positive resection margin was 83.38% with a specificity of 93.28%. The OS and the median patient survival time differed significantly according to the resection margin, i.e., 56.0% and 134.4 months in the R0 resection and 5.1% and 10.8 months in the R1/R2 resection group (p < 0.001). Conclusions: Preoperative CT findings could aid in planning surgery and determining the resectability using the high-risk findings of residual tumor, including liver invasion, bile duct invasion, and HA invasion. Key Points: • Liver invasion, bile duct invasion, and HA invasion were significant preoperative CT predictors for residual tumor in GB cancer. • HA invasion showed the highest OR on multivariate analysis and the highest predictor point on a nomogram for predicting a positive resection margin. • Association of two factors can predict positive resection margin with an accuracy of 83.38% and a specificity of 93.28%.

Original languageEnglish
Pages (from-to)6458-6468
Number of pages11
JournalEuropean Radiology
Volume29
Issue number12
DOIs
StatePublished - 1 Dec 2019

Fingerprint

Gallbladder Neoplasms
Residual Neoplasm
Hepatic Artery
Bile Ducts
Survival
Liver
Neoplasm Metastasis
Nomograms
Cholecystitis
Gallstones
Portal Vein
Multivariate Analysis
Lymph Nodes
Margins of Excision
Neoplasms

Keywords

  • Gallbladder
  • Multidetector computed tomography
  • Neoplasm
  • Residual tumor
  • Survival

Cite this

@article{e62534685fa6499781fa7988418a1266,
title = "Preoperative CT findings for prediction of resectability in patients with gallbladder cancer",
abstract = "Objectives: To predict residual tumor (R) classification in patients with a surgery for gallbladder (GB) cancer, using preoperative CT. Methods: One hundred seventy-three patients with GB cancer who underwent CT and subsequent surgery were included. Two radiologists assessed CT findings, including tumor morphology, location, T stage, adjacent organ invasion, hepatic artery (HA) invasion, portal vein invasion, lymph node metastasis, metastasis, resectability, gallstone, and combined cholecystitis. The R classification was categorized as no residual tumor (R0) and residual tumor (R1 or R2). We analyzed the correlation between CT findings and R classification. We also followed up the patients as long as five years and analyzed the relationship between the R classification and the overall survival (OS). Results: There were 134 patients with R0 and 39 patients with R1/R2. On multivariable analysis, liver invasion (Exp(B) = 3.19, p = 0.010), bile duct invasion (Exp(B) = 3.69, p = 0.031), and HA invasion (Exp(B) = 3.74, p = 0.039) were independent, significant predictors for residual tumor. When two of these three criteria were combined, the accuracy for predicting a positive resection margin was 83.38{\%} with a specificity of 93.28{\%}. The OS and the median patient survival time differed significantly according to the resection margin, i.e., 56.0{\%} and 134.4 months in the R0 resection and 5.1{\%} and 10.8 months in the R1/R2 resection group (p < 0.001). Conclusions: Preoperative CT findings could aid in planning surgery and determining the resectability using the high-risk findings of residual tumor, including liver invasion, bile duct invasion, and HA invasion. Key Points: • Liver invasion, bile duct invasion, and HA invasion were significant preoperative CT predictors for residual tumor in GB cancer. • HA invasion showed the highest OR on multivariate analysis and the highest predictor point on a nomogram for predicting a positive resection margin. • Association of two factors can predict positive resection margin with an accuracy of 83.38{\%} and a specificity of 93.28{\%}.",
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Preoperative CT findings for prediction of resectability in patients with gallbladder cancer. / Choi, Seo Youn; Kim, Jung Hoon; Park, Hyun Jeong; Han, Joon Koo.

In: European Radiology, Vol. 29, No. 12, 01.12.2019, p. 6458-6468.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Preoperative CT findings for prediction of resectability in patients with gallbladder cancer

AU - Choi, Seo Youn

AU - Kim, Jung Hoon

AU - Park, Hyun Jeong

AU - Han, Joon Koo

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Objectives: To predict residual tumor (R) classification in patients with a surgery for gallbladder (GB) cancer, using preoperative CT. Methods: One hundred seventy-three patients with GB cancer who underwent CT and subsequent surgery were included. Two radiologists assessed CT findings, including tumor morphology, location, T stage, adjacent organ invasion, hepatic artery (HA) invasion, portal vein invasion, lymph node metastasis, metastasis, resectability, gallstone, and combined cholecystitis. The R classification was categorized as no residual tumor (R0) and residual tumor (R1 or R2). We analyzed the correlation between CT findings and R classification. We also followed up the patients as long as five years and analyzed the relationship between the R classification and the overall survival (OS). Results: There were 134 patients with R0 and 39 patients with R1/R2. On multivariable analysis, liver invasion (Exp(B) = 3.19, p = 0.010), bile duct invasion (Exp(B) = 3.69, p = 0.031), and HA invasion (Exp(B) = 3.74, p = 0.039) were independent, significant predictors for residual tumor. When two of these three criteria were combined, the accuracy for predicting a positive resection margin was 83.38% with a specificity of 93.28%. The OS and the median patient survival time differed significantly according to the resection margin, i.e., 56.0% and 134.4 months in the R0 resection and 5.1% and 10.8 months in the R1/R2 resection group (p < 0.001). Conclusions: Preoperative CT findings could aid in planning surgery and determining the resectability using the high-risk findings of residual tumor, including liver invasion, bile duct invasion, and HA invasion. Key Points: • Liver invasion, bile duct invasion, and HA invasion were significant preoperative CT predictors for residual tumor in GB cancer. • HA invasion showed the highest OR on multivariate analysis and the highest predictor point on a nomogram for predicting a positive resection margin. • Association of two factors can predict positive resection margin with an accuracy of 83.38% and a specificity of 93.28%.

AB - Objectives: To predict residual tumor (R) classification in patients with a surgery for gallbladder (GB) cancer, using preoperative CT. Methods: One hundred seventy-three patients with GB cancer who underwent CT and subsequent surgery were included. Two radiologists assessed CT findings, including tumor morphology, location, T stage, adjacent organ invasion, hepatic artery (HA) invasion, portal vein invasion, lymph node metastasis, metastasis, resectability, gallstone, and combined cholecystitis. The R classification was categorized as no residual tumor (R0) and residual tumor (R1 or R2). We analyzed the correlation between CT findings and R classification. We also followed up the patients as long as five years and analyzed the relationship between the R classification and the overall survival (OS). Results: There were 134 patients with R0 and 39 patients with R1/R2. On multivariable analysis, liver invasion (Exp(B) = 3.19, p = 0.010), bile duct invasion (Exp(B) = 3.69, p = 0.031), and HA invasion (Exp(B) = 3.74, p = 0.039) were independent, significant predictors for residual tumor. When two of these three criteria were combined, the accuracy for predicting a positive resection margin was 83.38% with a specificity of 93.28%. The OS and the median patient survival time differed significantly according to the resection margin, i.e., 56.0% and 134.4 months in the R0 resection and 5.1% and 10.8 months in the R1/R2 resection group (p < 0.001). Conclusions: Preoperative CT findings could aid in planning surgery and determining the resectability using the high-risk findings of residual tumor, including liver invasion, bile duct invasion, and HA invasion. Key Points: • Liver invasion, bile duct invasion, and HA invasion were significant preoperative CT predictors for residual tumor in GB cancer. • HA invasion showed the highest OR on multivariate analysis and the highest predictor point on a nomogram for predicting a positive resection margin. • Association of two factors can predict positive resection margin with an accuracy of 83.38% and a specificity of 93.28%.

KW - Gallbladder

KW - Multidetector computed tomography

KW - Neoplasm

KW - Residual tumor

KW - Survival

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DO - 10.1007/s00330-019-06323-4

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VL - 29

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JO - European radiology

JF - European radiology

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