Balakrishnan Anita, Barmpounakis Petros, Demiris Nikolaos, Andersson Bodil, Brañes Alejandro, de Aretxabala Xavier, Eilard Malin Sternby, Gibbs Paul, Harper Simon J F, Huguet Emmanuel L, Jah Asif, Kosmoliaptsis Vasilis, Lendoire Javier, Liau Siong S, Maithel Shishir, Martin Jack L, Noel Colin, Praseedom Raaj K, Serrablo Alejandro, Adsay Volkan
Department of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Department of Surgery, University of Cambridge, Cambridge, UK.
BJS Open. 2025 May 7;9(3). doi: 10.1093/bjsopen/zraf056.
Nodal assessment in gallbladder cancer remains challenging, particularly in incidental gallbladder cancer. This understages the number of patients with node-positive disease, resulting in prognostic inaccuracy and insufficient adjuvant treatment. This study aimed to identify risk factors for positive nodes in gallbladder cancer and to compare prognostic discrimination of available nodal staging parameters.
This international cohort study assessed gallbladder cancer resections undertaken between 1 January 2010 and 31 December 2020. Logistic regression was used to identify risk factors for node-positive status and develop a risk prediction score for positive nodes. Nodal staging models, including nodal site, number of positive nodes, and positive node ratio were compared for greatest prognostic discrimination in gallbladder cancer.
A total of 3676 patients underwent gallbladder cancer resection across 133 centres in 41 countries. Tumour (T) stage (T2, P = 0.012; T3, P = 0.002; and T4, P < 0.001), lymphovascular and perineural infiltration (P < 0.001), and tumour differentiation (P < 0.001) carried the greatest risk of positive nodes. These three parameters comprised the OMEGA Node Positivity Prediction Score (OMEGA-NOPPS) with C-statistics of 0.81 (95% confidence interval 0.78 to 0.84) in the training data set and 0.79 (0.73 to 0.85) in the test data set for identification of node-positive status, highlighting a ≥ 20% increased risk of positive nodes in poorly differentiated tumours with lymphovascular and perineural infiltration despite T1 disease.
Data from this large multicentre study confirmed that the number of positive nodes is the most discriminative prognostic model for nodal staging in gallbladder cancer. OMEGA-NOPPS provides three simple parameters to stratify nodal involvement according to risk. Incidental gallbladder cancer with lymphovascular and perineural infiltration and poorly differentiated tumours, including early T stages, should be considered for further treatment.
胆囊癌的淋巴结评估仍然具有挑战性，尤其是在意外胆囊癌中。这低估了淋巴结阳性疾病患者的数量，导致预后不准确和辅助治疗不足。本研究旨在确定胆囊癌淋巴结阳性的危险因素，并比较现有淋巴结分期参数的预后判别能力。
这项国际队列研究评估了2010年1月1日至2020年12月31日期间进行的胆囊癌切除术。采用逻辑回归来确定淋巴结阳性状态的危险因素，并开发淋巴结阳性的风险预测评分。比较了包括淋巴结部位、阳性淋巴结数量和阳性淋巴结比率在内的淋巴结分期模型，以确定胆囊癌中最大的预后判别能力。
共有3676例患者在41个国家的133个中心接受了胆囊癌切除术。肿瘤（T）分期（T2，P = 0.012；T3，P = 0.002；T4，P < 0.001）、淋巴管和神经周围浸润（P < 0.001）以及肿瘤分化（P < 0.001）是淋巴结阳性的最大风险因素。这三个参数构成了OMEGA淋巴结阳性预测评分（OMEGA-NOPPS），在训练数据集中识别淋巴结阳性状态的C统计量为0.81（95%置信区间0.78至0.84），在测试数据集中为0.79（0.73至0.85），突出显示尽管为T1期疾病，但伴有淋巴管和神经周围浸润的低分化肿瘤中淋巴结阳性风险增加≥20%。
这项大型多中心研究的数据证实，阳性淋巴结数量是胆囊癌淋巴结分期中最具判别力的预后模型。OMEGA-NOPPS提供了三个简单参数，可根据风险对淋巴结受累情况进行分层。对于伴有淋巴管和神经周围浸润以及低分化肿瘤的意外胆囊癌，包括早期T分期，应考虑进一步治疗。
