Evidence map›Paper›PMID 40407730›Full record

ArticleBJS open2025

Assessment of nodal staging and risk factors for nodal involvement in gallbladder cancer.

Anita Balakrishnan, Petros Barmpounakis, Nikolaos Demiris, Bodil Andersson, Alejandro Brañes, Xavier de Aretxabala, Malin Sternby Eilard, Paul Gibbs, Simon J F Harper, Emmanuel L Huguet and 11 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BJS open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed.

  1. Article
  2. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

21 authors.

Anita BalakrishnanDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.ORCID 0000-0002-9172-3938
Petros BarmpounakisCambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Nikolaos DemirisCambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Bodil AnderssonDepartment of Surgery, Lund University, Skane University Hospital, Lund, Sweden.
Alejandro BrañesDepartment of Hepatopancreatobiliary Surgery, Hospital Sotero del Rio, Puente Alto, Chile.ORCID 0000-0002-1512-1046
Xavier de AretxabalaDepartment of Digestive Surgery, Hepato-Pancreato-Biliary Surgery Unit, Surgery Service, Gallbladder Consortium Chile, Sotero del Rio Hospital and Clinica Alemana, Santiago, Chile.
Malin Sternby EilardTransplantation Centre, Sahlgrenska University Hospital, and Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Paul GibbsDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Simon J F HarperDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Emmanuel L HuguetDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Asif JahDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Vasilis KosmoliaptsisDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Javier LendoireDepartment of Surgery, University of Buenos Aires, Hospital Dr Cosme Argerich, Buenos Aires, Argentina.
Siong S LiauDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Shishir MaithelDivision of Surgical Oncology, Lurie Comprehensive Cancer Centre, Northwestern University, Chicago, USA.
Jack L MartinDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Colin NoelGastrointestinal Surgery and Hepatopancreatobiliary Surgery, Department of Surgery, University of the Free State, Bloemfontein, South Africa.
Raaj K PraseedomDepartment of Hepatopancreatobiliary Surgery, Cambridge University Hospitals NHS Foundation Trust, University of Cambridge, Cambridge, UK.
Alejandro SerrabloDepartment of Hepatopancreatobiliary Surgery, Miguel Servet University Hospital, Zaragoza, Spain.
Volkan AdsayDepartment of Pathology, Koç University Hospital, Istanbul, Turkey.
OMEGA Study Investigators

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundNodal 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.

methodsThis 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.

resultsA 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.

conclusionData 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.

Indexed as

Gallbladder NeoplasmsLymphatic MetastasisLymph NodesAdultAgedCholecystectomyFemaleHumansMaleMiddle AgedNeoplasm StagingPrognosisRisk AssessmentRisk Factors

Identifiers

PMID40407730
PMCPMC12100740

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.