Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma

Stefan Buettner, Georgios Antonios Margonis, Yuhree Kim, Faiz Gani, Cecilia G. Ethun, George A. Poultsides, Thuy Tran, Kamran Idrees, Chelsea A. Isom, Ryan C. Fields, Bradley Krasnick, Sharon M. Weber, Ahmed Salem, Robert C G Martin, Charles R. Scoggins, Perry Shen, Harveshp D. Mogal, Carl Schmidt, Eliza Beal, Ioannis Hatzaras & 3 others Rivfka Shenoy, Shishir K. Maithel, Timothy M. Pawlik

Research output: Contribution to journalArticle

Abstract

Background: While survival after malignancies is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant by accounting for “accrued” survival time as time progresses. We sought to compare actuarial and CS among patients with gallbladder carcinoma (GBC). Methods: A total of 312 patients who underwent curative intent surgery for GBC between 2000 and 2014 were identified using a multi-institutional database. Overall survival (OS) was estimated using the Kaplan–Meier method. CS was calculated as the probability of surviving an additional 3 years at year “x” after surgery using the formula CS3 = S(x+3)/Sx. Results: Among all patients, the median actuarial OS was 24.8 months (IQR 13.3–88.9). While actuarial survival decreased over time, 3-year CS (CS3) increased, with CS3 at 2 years after surgery noted to be 61.8 % compared with the 5-year actuarial OS of 31.6 %. Factors associated with reduced actuarial OS were positive margin status (HR 3.61, 95 % CI 2.47–5.26), increasing tumor size (HR = 1.02, 95 % CI 1.01–1.02), higher tumor grade (HR 2.98, 95 % CI 1.47–6.04), residual disease at repeat resection (HR = 2.78, 95 % CI 1.49–3.49, p < 0.001), and lymph node metastasis (HR = 1.95, 95 % CI 1.39–2.75, all p < 0.001). The calculated CS3 exceeded the actuarial survival within each high-risk patient subgroup. For example, patients with residual disease at repeat resection had an actuarial survival 23.1 % at 5 years versus a CS3 of 56.3 % in patients alive at 2 years (Δ = 33.2 %). Conclusions: CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients. CS estimates can be used to accurately predict survival and guide clinical decision making.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalAnnals of Surgical Oncology
DOIs
StateAccepted/In press - Aug 5 2016

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Gallbladder
Carcinoma
Survival
Neoplasms

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Buettner, S., Margonis, G. A., Kim, Y., Gani, F., Ethun, C. G., Poultsides, G. A., ... Pawlik, T. M. (Accepted/In press). Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma. Annals of Surgical Oncology, 1-9. https://doi.org/10.1245/s10434-016-5470-2

Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma. / Buettner, Stefan; Margonis, Georgios Antonios; Kim, Yuhree; Gani, Faiz; Ethun, Cecilia G.; Poultsides, George A.; Tran, Thuy; Idrees, Kamran; Isom, Chelsea A.; Fields, Ryan C.; Krasnick, Bradley; Weber, Sharon M.; Salem, Ahmed; Martin, Robert C G; Scoggins, Charles R.; Shen, Perry; Mogal, Harveshp D.; Schmidt, Carl; Beal, Eliza; Hatzaras, Ioannis; Shenoy, Rivfka; Maithel, Shishir K.; Pawlik, Timothy M.

In: Annals of Surgical Oncology, 05.08.2016, p. 1-9.

Research output: Contribution to journalArticle

Buettner, S, Margonis, GA, Kim, Y, Gani, F, Ethun, CG, Poultsides, GA, Tran, T, Idrees, K, Isom, CA, Fields, RC, Krasnick, B, Weber, SM, Salem, A, Martin, RCG, Scoggins, CR, Shen, P, Mogal, HD, Schmidt, C, Beal, E, Hatzaras, I, Shenoy, R, Maithel, SK & Pawlik, TM 2016, 'Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma', Annals of Surgical Oncology, pp. 1-9. https://doi.org/10.1245/s10434-016-5470-2
Buettner, Stefan ; Margonis, Georgios Antonios ; Kim, Yuhree ; Gani, Faiz ; Ethun, Cecilia G. ; Poultsides, George A. ; Tran, Thuy ; Idrees, Kamran ; Isom, Chelsea A. ; Fields, Ryan C. ; Krasnick, Bradley ; Weber, Sharon M. ; Salem, Ahmed ; Martin, Robert C G ; Scoggins, Charles R. ; Shen, Perry ; Mogal, Harveshp D. ; Schmidt, Carl ; Beal, Eliza ; Hatzaras, Ioannis ; Shenoy, Rivfka ; Maithel, Shishir K. ; Pawlik, Timothy M. / Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma. In: Annals of Surgical Oncology. 2016 ; pp. 1-9.
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abstract = "Background: While survival after malignancies is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant by accounting for “accrued” survival time as time progresses. We sought to compare actuarial and CS among patients with gallbladder carcinoma (GBC). Methods: A total of 312 patients who underwent curative intent surgery for GBC between 2000 and 2014 were identified using a multi-institutional database. Overall survival (OS) was estimated using the Kaplan–Meier method. CS was calculated as the probability of surviving an additional 3 years at year “x” after surgery using the formula CS3 = S(x+3)/Sx. Results: Among all patients, the median actuarial OS was 24.8 months (IQR 13.3–88.9). While actuarial survival decreased over time, 3-year CS (CS3) increased, with CS3 at 2 years after surgery noted to be 61.8 {\%} compared with the 5-year actuarial OS of 31.6 {\%}. Factors associated with reduced actuarial OS were positive margin status (HR 3.61, 95 {\%} CI 2.47–5.26), increasing tumor size (HR = 1.02, 95 {\%} CI 1.01–1.02), higher tumor grade (HR 2.98, 95 {\%} CI 1.47–6.04), residual disease at repeat resection (HR = 2.78, 95 {\%} CI 1.49–3.49, p < 0.001), and lymph node metastasis (HR = 1.95, 95 {\%} CI 1.39–2.75, all p < 0.001). The calculated CS3 exceeded the actuarial survival within each high-risk patient subgroup. For example, patients with residual disease at repeat resection had an actuarial survival 23.1 {\%} at 5 years versus a CS3 of 56.3 {\%} in patients alive at 2 years (Δ = 33.2 {\%}). Conclusions: CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients. CS estimates can be used to accurately predict survival and guide clinical decision making.",
author = "Stefan Buettner and Margonis, {Georgios Antonios} and Yuhree Kim and Faiz Gani and Ethun, {Cecilia G.} and Poultsides, {George A.} and Thuy Tran and Kamran Idrees and Isom, {Chelsea A.} and Fields, {Ryan C.} and Bradley Krasnick and Weber, {Sharon M.} and Ahmed Salem and Martin, {Robert C G} and Scoggins, {Charles R.} and Perry Shen and Mogal, {Harveshp D.} and Carl Schmidt and Eliza Beal and Ioannis Hatzaras and Rivfka Shenoy and Maithel, {Shishir K.} and Pawlik, {Timothy M.}",
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T1 - Changing Odds of Survival Over Time among Patients Undergoing Surgical Resection of Gallbladder Carcinoma

AU - Buettner, Stefan

AU - Margonis, Georgios Antonios

AU - Kim, Yuhree

AU - Gani, Faiz

AU - Ethun, Cecilia G.

AU - Poultsides, George A.

AU - Tran, Thuy

AU - Idrees, Kamran

AU - Isom, Chelsea A.

AU - Fields, Ryan C.

AU - Krasnick, Bradley

AU - Weber, Sharon M.

AU - Salem, Ahmed

AU - Martin, Robert C G

AU - Scoggins, Charles R.

AU - Shen, Perry

AU - Mogal, Harveshp D.

AU - Schmidt, Carl

AU - Beal, Eliza

AU - Hatzaras, Ioannis

AU - Shenoy, Rivfka

AU - Maithel, Shishir K.

AU - Pawlik, Timothy M.

PY - 2016/8/5

Y1 - 2016/8/5

N2 - Background: While survival after malignancies is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant by accounting for “accrued” survival time as time progresses. We sought to compare actuarial and CS among patients with gallbladder carcinoma (GBC). Methods: A total of 312 patients who underwent curative intent surgery for GBC between 2000 and 2014 were identified using a multi-institutional database. Overall survival (OS) was estimated using the Kaplan–Meier method. CS was calculated as the probability of surviving an additional 3 years at year “x” after surgery using the formula CS3 = S(x+3)/Sx. Results: Among all patients, the median actuarial OS was 24.8 months (IQR 13.3–88.9). While actuarial survival decreased over time, 3-year CS (CS3) increased, with CS3 at 2 years after surgery noted to be 61.8 % compared with the 5-year actuarial OS of 31.6 %. Factors associated with reduced actuarial OS were positive margin status (HR 3.61, 95 % CI 2.47–5.26), increasing tumor size (HR = 1.02, 95 % CI 1.01–1.02), higher tumor grade (HR 2.98, 95 % CI 1.47–6.04), residual disease at repeat resection (HR = 2.78, 95 % CI 1.49–3.49, p < 0.001), and lymph node metastasis (HR = 1.95, 95 % CI 1.39–2.75, all p < 0.001). The calculated CS3 exceeded the actuarial survival within each high-risk patient subgroup. For example, patients with residual disease at repeat resection had an actuarial survival 23.1 % at 5 years versus a CS3 of 56.3 % in patients alive at 2 years (Δ = 33.2 %). Conclusions: CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients. CS estimates can be used to accurately predict survival and guide clinical decision making.

AB - Background: While survival after malignancies is traditionally reported as actuarial survival, conditional survival (CS) may be more clinically relevant by accounting for “accrued” survival time as time progresses. We sought to compare actuarial and CS among patients with gallbladder carcinoma (GBC). Methods: A total of 312 patients who underwent curative intent surgery for GBC between 2000 and 2014 were identified using a multi-institutional database. Overall survival (OS) was estimated using the Kaplan–Meier method. CS was calculated as the probability of surviving an additional 3 years at year “x” after surgery using the formula CS3 = S(x+3)/Sx. Results: Among all patients, the median actuarial OS was 24.8 months (IQR 13.3–88.9). While actuarial survival decreased over time, 3-year CS (CS3) increased, with CS3 at 2 years after surgery noted to be 61.8 % compared with the 5-year actuarial OS of 31.6 %. Factors associated with reduced actuarial OS were positive margin status (HR 3.61, 95 % CI 2.47–5.26), increasing tumor size (HR = 1.02, 95 % CI 1.01–1.02), higher tumor grade (HR 2.98, 95 % CI 1.47–6.04), residual disease at repeat resection (HR = 2.78, 95 % CI 1.49–3.49, p < 0.001), and lymph node metastasis (HR = 1.95, 95 % CI 1.39–2.75, all p < 0.001). The calculated CS3 exceeded the actuarial survival within each high-risk patient subgroup. For example, patients with residual disease at repeat resection had an actuarial survival 23.1 % at 5 years versus a CS3 of 56.3 % in patients alive at 2 years (Δ = 33.2 %). Conclusions: CS provides a more accurate, dynamic estimate for survival, especially among high-risk patients. CS estimates can be used to accurately predict survival and guide clinical decision making.

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