Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China.
BMC Gastroenterol. 2022 Apr 21;22(1):200. doi: 10.1186/s12876-022-02281-2.
Gallbladder cancer is associated with late diagnosis and poor prognosis. Current study aims to develop a prognostic nomogram for predicting survival of gallbladder cancer patients after surgery.
Two large cohorts were included in this analysis. One consisted of 1753 gallbladder cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database, and the other consisted of 239 patients from Shanghai Renji hospital. Significant prognostic factors were identified and integrated to develop the nomogram. Then the model was subjected to bootstrap internal validation and external validation.
Univariate and multivariate analysis indicated that age, tumor histology, T-stage, N-stage and M-stage were significant prognostic factors, which were all included to build the nomogram. The model showed good discrimination, with a concordance index (C-index) of 0.724 (95% CI, 0.708-0.740), and good calibration. Application of the nomogram in the validation cohort still presented good discrimination (C-index, 0.715 [95% CI 0.672-0.758]) and good calibration. In the primary cohort, the C-index of the nomogram was 0.724, which was significantly higher than the Nevin staging system (C-index = 0.671; P < 0.001) and the 8th TNM staging system (C-index = 0.682; P < 0.001). In the validation cohort, the C-index of the nomogram was 0.715, which was also higher than the Nevin staging system (C-index = 0.692; P < 0.05) and the 8th TNM staging system (C-index = 0.688; P = 0.06).
The proposed nomogram resulted in more-accurate prognostic prediction for patients with gallbladder cancer after surgery.
胆囊癌诊断较晚，预后不良。本研究旨在建立一种预测胆囊癌患者手术后生存的预后列线图。
本研究纳入了两个大型队列。其中一个队列包括来自 Surveillance, Epidemiology, and End Results（SEER）数据库的 1753 名胆囊癌患者，另一个队列包括来自上海仁济医院的 239 名患者。通过单因素和多因素分析确定了显著的预后因素，并将其整合到列线图中。然后，对模型进行了 bootstrap 内部验证和外部验证。
单因素和多因素分析表明，年龄、肿瘤组织学、T 分期、N 分期和 M 分期是显著的预后因素，这些因素均被纳入到列线图中。该模型具有良好的判别能力，一致性指数（C-index）为 0.724（95%CI，0.708-0.740），校准度良好。在验证队列中应用该列线图仍具有良好的判别能力（C-index，0.715 [95%CI 0.672-0.758]）和良好的校准度。在原始队列中，列线图的 C-index 为 0.724，明显高于 Nevin 分期系统（C-index=0.671；P<0.001）和第 8 版 TNM 分期系统（C-index=0.682；P<0.001）。在验证队列中，列线图的 C-index 为 0.715，也高于 Nevin 分期系统（C-index=0.692；P<0.05）和第 8 版 TNM 分期系统（C-index=0.688；P=0.06）。
该列线图可更准确地预测胆囊癌患者手术后的预后。
