Chen Mingyu, Lin Jian, Cao Jiasheng, Zhu Hepan, Zhang Bin, Wu Angela, Cai Xiujun
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.
Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.
Hepatobiliary Surg Nutr. 2019 Oct;8(5):480-489. doi: 10.21037/hbsn.2019.03.02.
Due to absence of large, prospective, randomized, clinical trial data, the potential survival benefit of lymphadenectomy with different number of regional lymph nodes (LNs) remains controversial. We aim to create a predicting model to help estimate individualized potential survival benefit of lymphadenectomy with more regional LNs for patients with resected gallbladder cancer (GBC).
Patients with resected GBC were selected from the Surveillance, Epidemiology, and End Results database who were diagnosed between 2004 and 2014. Covariates included age, race, sex, grade, histological stage, tumor sizes and receipt of non-primary surgery. Two types of multivariate survival regression models were constructed and compared. The best model performance was tested by the external validation data from our hospital.
A total of 1,669 patients met the inclusion criteria for this study. The lognormal survival model showed the best performance and was tested by the external validation data, including 193 patients with resected GBC from our hospital. Nomograms, which based on the accelerated failure time parametric survival model, were built to estimate individualized survival. C-index, was up to 0.754 and 0.710 in internal validation for more and less regional LNs removed, respectively. Both of internal and external calibration curves showed good agreement between predicted and observed outcomes in the 1-, 3-, and 5-year overall survival (OS).
A predicting model can be used as a decision model to predict which patients may obtain benefit from lymphadenectomy with more regional LNs.
由于缺乏大型、前瞻性、随机临床试验数据，不同区域淋巴结（LN）数量的淋巴结清扫术的潜在生存获益仍存在争议。我们旨在创建一个预测模型，以帮助估计行更多区域LN清扫术的胆囊癌（GBC）切除患者的个体化潜在生存获益。
从监测、流行病学和最终结果数据库中选取2004年至2014年期间诊断为GBC且已接受手术切除的患者。协变量包括年龄、种族、性别、分级、组织学分期、肿瘤大小以及是否接受非初次手术。构建并比较了两种多变量生存回归模型。通过我院的外部验证数据对最佳模型性能进行了测试。
共有1669例患者符合本研究的纳入标准。对数正态生存模型表现最佳，并通过外部验证数据进行了测试，其中包括我院193例接受GBC切除的患者。基于加速失效时间参数生存模型构建了列线图，以估计个体化生存情况。在内部验证中，对于切除更多和更少区域LN的情况，C指数分别高达0.754和0.710。内部和外部校准曲线均显示，在1年、3年和5年总生存（OS）方面，预测结果与观察结果之间具有良好的一致性。
预测模型可作为一种决策模型，用于预测哪些患者可能从行更多区域LN清扫术中获益。
