Abstract 319P
Background
Gallbladder cancer (GBC) and benign inflammatory disease of the gallbladder are clinical entities that are very difficult to separate prior to histological analysis, especially in the xanthogranolumatous cholecystitis condition. Currently, there is no available accurate preoperative method that can distinguish malignant from benign diagnosis of the gallbladder, leading to a number of extended resections not indicated should the postoperative pathology have been known prior to surgery.
Methods
This is a retrospective observational single-centre study including patients operated, under suspision of GBC, with bisegmentectomy (or wedge resection) and lymph adenectomy at Karolinska University Hospital during the years 2009-2020. Preoperative plasma from a prospective biobank was analysed using the 7586 proteomics panel from SomaLink and the clinical data of the patients, including results from the histological analysis, were collected. We analyzed the proteomic data using machine learning methods (LASSO regression) to select proteins with high potential to predict if the patients have benign disease or malignant tumour. We also identified the proteins that are linked to the difference between GBC and benign disease using Mann-Whitney statistical test of significance and elastic net regression.
Results
We identified 13 serum proteins with high predictive potential. A linear combination of 6 to 8 of these proteins can distinguish GBC from benign disease with a an accuracy of 94 to 99 %. These 13 proteins were capable to cluster the patients into two groups largely corresponding to the benign and the GBC patients. However, 10 % of the patients were placed in a “gray-zone” where the groups superpose. In addition, we list 604 proteins with strong linkage to the difference between benign disease and malignant tumours in the gallbladder. These proteins are mainly involved in the axon guidance pathways, the coagulation and complement cascades pathway and other pathways known in tumour progression.
Conclusions
Proteins in the pre-operative serum are informative of the benign or GBC patients. A small number of these proteins (6 to 8) can be screened and used to assist in decision making for suspected gallbladder cancer.
Legal entity responsible for the study
Ernesto Sparellid.
Funding
Karolinska Institute, Karolinska University Hospital.
Disclosure
All authors have declared no conflicts of interest.