Ma Zuyi, Dong Fengying, Li Zhenchong, Zheng Zehao, Zhou Zixuan, Zhuang Hongkai, Liu Chunsheng, Huang Bowen, Huang Shanzhou, Zou Yiping, Yang LinLing, Gong Yuanfeng, Zhang Chuanzhao, Hou Baohua
Shantou University of Medical College, Shantou 515000, China.
Department of General Surgery, Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510080, China.
J Oncol. 2021 Feb 8;2021:6619149. doi: 10.1155/2021/6619149. eCollection 2021.
Gallbladder cancer (GBC), which accounts for more than 80% of biliary tract malignancies, has a poor prognosis with an overall 5-year survival less than 10%. The study aimed to identify risk factors and develop a predictive model for GBC following surgical resection.
98 GBC patients who underwent surgical resection from Guangdong Provincial People's Hospital were enrolled in the study. Cox-regression analysis was performed to identify significant prognostic factors. A nomogram was constructed and Harrell's concordance index, calibration plot, and decision cure analysis were used to evaluate the discrimination and calibration of the nomogram.
Liver resection, tumor size, perineural invasion, surgical margin, and liver invasion were identified as independent risk factors for overall survival (OS) in GBC patients who underwent surgical resection. Based on the selected risk factors, a novel nomogram was constructed. The C-index of the nomogram was 0.777, which was higher than the American Joint Committee on Cancer (AJCC) staging system (0.724) and Nevin staging system (0.659). Decision cure analysis revealed that the nomogram had a better net benefit and the calibration curves for the 1-, 3-, and 5-year survival probabilities were also well matched with the actual survival rates. Lastly, high-risk GBC were stratified based on the scores of the nomogram and we found high-risk GBC were associated with both worse OS and disease-free survival (DFS).
We developed a nomogram showing a better predictive capacity for patients' survival of resected GBC than the AJCC staging systems. The established model may help to stratify high-risk GBC and facilitate decision-making in the clinic.
胆囊癌（GBC）占胆道恶性肿瘤的80%以上，预后较差，总体5年生存率低于10%。本研究旨在确定胆囊癌手术切除后的危险因素并建立预测模型。
本研究纳入了98例在广东省人民医院接受手术切除的胆囊癌患者。采用Cox回归分析确定显著的预后因素。构建了列线图，并使用Harrell一致性指数、校准图和决策曲线分析来评估列线图的辨别力和校准度。
肝切除、肿瘤大小、神经周围侵犯、手术切缘和肝侵犯被确定为接受手术切除的胆囊癌患者总生存期（OS）的独立危险因素。基于所选危险因素构建了一个新的列线图。该列线图的C指数为0.777，高于美国癌症联合委员会（AJCC）分期系统（0.724）和Nevin分期系统（0.659）。决策曲线分析显示，列线图具有更好的净效益，1年、3年和5年生存概率的校准曲线也与实际生存率良好匹配。最后，根据列线图得分对高危胆囊癌进行分层，我们发现高危胆囊癌与较差的总生存期和无病生存期（DFS）均相关。
我们开发的列线图对胆囊癌切除患者生存的预测能力优于AJCC分期系统。所建立的模型可能有助于对高危胆囊癌进行分层，并促进临床决策。
