Department of Radiology, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, 170 Jomaru-ro, Wonmi-gu, Bucheon, 14584, South Korea.
Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
Eur Radiol. 2021 May;31(5):3336-3346. doi: 10.1007/s00330-020-07402-7. Epub 2020 Nov 13.
To establish a prognostic nomogram for patients undergoing R0 resection for gallbladder cancer based on preoperative CT.
A total of 151 patients (64 males, 87 females; mean age, 73.26 years) with gallbladder cancer who underwent CT and surgery with margin-negative resection were retrospectively collected at two tertiary institutions. The demographic and radiologic parameters were analyzed using univariate and multivariate Cox regression analyses to identify independent prognostic factors. The final CT-based nomogram was constructed to predict prognosis after curative resection of gallbladder cancer. Calibration curves for the survival probabilities were obtained for internal validation.
Mass-forming type (hazard ratio [HR], 28.80), bile duct invasion (HR, 4.76), duodenal invasion (HR, 6.32), colon invasion (HR, 4.37), gallstones (HR, 0.09), and cholecystitis (HR, 2.56) were significant independent predictors for recurrence-free survival (p < .05). Mass-forming type (HR, 8.16, p < .001), bile duct invasion (HR, 2.92, p = .013), duodenal invasion (HR, 3.72, p = .012), and regional lymph node metastasis (HR, 2.07, p = .043) were independent predictors of poor cancer-specific survival (CSS) and were used to construct the nomogram. The nomogram showed a good predictive ability for the probabilities of survival on the calibration curves, and the concordance index of the model in predicting CSS was .768.
Preoperative CT findings could predict the prognosis of gallbladder cancer, and the CT-based nomogram accurately predicted CSS in patients with gallbladder cancer after attempted curative resection.
• Among the preoperative imaging features, mass-forming type, bile duct invasion, duodenal invasion, and regional lymph node metastasis were independent predictors of poor cancer-specific survival. • The nomogram constructed using preoperative CT findings showed a good predictive ability for the survival on calibration curves, and the concordance index of the model in predicting cancer-specific survival was 0.768.
基于术前 CT 建立胆囊癌 R0 切除患者的预后列线图。
本研究回顾性收集了在两家三级医疗机构接受 CT 检查和边缘阴性切除手术的 151 例胆囊癌患者（男 64 例，女 87 例；平均年龄 73.26 岁）。使用单变量和多变量 Cox 回归分析对人口统计学和影像学参数进行分析，以确定独立的预后因素。最后，基于 CT 构建预测胆囊癌根治性切除后预后的列线图。通过内部验证获得生存概率的校准曲线。
肿块形成型（风险比 [HR]，28.80）、胆管侵犯（HR，4.76）、十二指肠侵犯（HR，6.32）、结肠侵犯（HR，4.37）、胆囊结石（HR，0.09）和胆囊炎（HR，2.56）是无复发生存（p < .05）的显著独立预测因素。肿块形成型（HR，8.16，p < .001）、胆管侵犯（HR，2.92，p = .013）、十二指肠侵犯（HR，3.72，p = .012）和区域淋巴结转移（HR，2.07，p = .043）是不良癌症特异性生存（CSS）的独立预测因素，并用于构建列线图。该列线图在校准曲线上显示了良好的生存概率预测能力，模型预测 CSS 的一致性指数为.768。
术前 CT 表现可预测胆囊癌的预后，基于术前 CT 的列线图可准确预测胆囊癌根治性切除术后的 CSS。
在术前影像学特征中，肿块形成型、胆管侵犯、十二指肠侵犯和区域淋巴结转移是不良 CSS 的独立预测因素。
使用术前 CT 结果构建的列线图在预测校准曲线上的生存方面具有良好的预测能力，该模型预测癌症特异性生存的一致性指数为 0.768。
