Occult Nodal Disease in Gallbladder Cancer: An International Multi-institutional Analysis and Preoperative Risk...

Area of Science:

• Oncology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Accurate preoperative nodal staging is crucial but challenging in gallbladder cancer (GBC).
• A significant number of patients presumed node-negative on imaging have occult nodal disease (OND) upon surgical exploration.
• This study quantifies the OND burden and identifies predictive preoperative factors.

Purpose of the Study:

• To determine the prevalence of occult nodal disease (OND) in clinically node-negative (cN0) gallbladder cancer (GBC) patients.
• To identify preoperative clinical and serological factors associated with OND in GBC.
• To develop a risk stratification model for OND in GBC.

Main Methods:

• Retrospective analysis of an international multi-institutional database of GBC patients undergoing curative-intent resection.
• Multivariable logistic regression analysis to identify predictors of OND among cN0 patients.
• Log-transformation of CA19-9 and systemic immune-inflammation index (SII) for modeling.

Main Results:

• Among 142 cN0 patients, 47 (33.1%) had OND.
• Higher ln(SII), ln(CA19-9), and preoperative jaundice were independently associated with OND.
• OND rates increased with the number of elevated markers: 17.1% (0 markers), 44.8% (1 marker), and 73.6% (2-3 markers).

Conclusions:

• Approximately one-third of clinically node-negative GBC patients harbor occult nodal disease.
• Preoperative jaundice, elevated CA19-9, and elevated SII are independent predictors of OND.
• These markers offer a simple risk stratification tool to guide further staging and treatment decisions.