Chen Mingyu, Li Shijie, Topatana Win, Lv Xiaozhong, Cao Jiasheng, Hu Jiahao, Lin Jian, Juengpanich Sarun, Shen Jiliang, Cai Xiujun
Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, China.
Front Oncol. 2021 Jan 11;10:537789. doi: 10.3389/fonc.2020.537789. eCollection 2020.
The management of gallbladder cancer (GBC) patients with recurrence who need additional therapy or intensive follow-up remains controversial. Therefore, we aim to develop a nomogram to predict survival in GBC patients with recurrence after surgery.
A total of 313 GBC patients with recurrence from our center was identified as a primary cohort, which were randomly divided into a training cohort (N = 209) and an internal validation cohort (N = 104). In addition, 105 patients from other centers were selected as an external validation cohort. Independent prognostic factors, identified by univariate and multivariable analysis, were used to construct a nomogram. The performance of this nomogram was measured using Harrell's concordance index (C-index) and calibration curves.
Our nomogram was established by four factors, including time-to-recurrence, site of recurrence, CA19-9 at recurrence, and treatment of recurrence. The C-index of this nomogram in the training, internal and external validation cohort was 0.871, 0.812, and 0.754, respectively. The calibration curves showed an optimal agreement between nomogram prediction and actual observation. Notably, this nomogram could accurately stratify patients into different risk subgroups, which allowed more significant distinction of Kaplan-Meier curves than that of using T category. The 3-year post-recurrence survival (PRS) rates in the low-, medium-, and high-risk subgroups from the external validation cohort were 53.3, 26.2, and 4.1%, respectively.
This nomogram provides a tool to predict 1- and 3-year PRS rates in GBC patients with recurrence after surgery.
对于需要额外治疗或强化随访的复发性胆囊癌（GBC）患者的管理仍存在争议。因此，我们旨在开发一种列线图来预测GBC术后复发患者的生存情况。
从我们中心共识别出313例复发性GBC患者作为主要队列，将其随机分为训练队列（N = 209）和内部验证队列（N = 104）。此外，选择来自其他中心的105例患者作为外部验证队列。通过单因素和多因素分析确定的独立预后因素用于构建列线图。使用Harrell一致性指数（C指数）和校准曲线来衡量该列线图的性能。
我们的列线图由四个因素建立，包括复发时间、复发部位、复发时的CA19-9以及复发治疗。该列线图在训练队列、内部验证队列和外部验证队列中的C指数分别为0.871、0.812和0.754。校准曲线显示列线图预测与实际观察之间具有最佳一致性。值得注意的是，该列线图可以准确地将患者分层为不同的风险亚组，与使用T分类相比，其Kaplan-Meier曲线的区分度更大。外部验证队列中低、中、高风险亚组的3年复发后生存率（PRS）分别为53.3%、26.2%和4.1%。
该列线图为预测GBC术后复发患者的1年和3年PRS率提供了一种工具。
