Cao Peng, Hong Haijie, Yu Zijian, Chen Guodong, Qi Shuo
Department of Hepatopancreatobiliary Surgery, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China.
Department of Hepatobiliary Surgery and Fujian Institute of Hepatobiliary Surgery, Fujian Medical University Union Hospital, Fujian Medical University Cancer Center, Fuzhou, China.
Front Nutr. 2022 May 4;9:850971. doi: 10.3389/fnut.2022.850971. eCollection 2022.
Gallbladder carcinoma (GBC) is the most common malignancy of the biliary tract, with a 5-year survival rate of 5%. The prognostic models to predict the prognosis of patients with GBC remain controversial. Therefore, to construct a prognosis prediction of GBC, a retrospective cohort study was carried out to investigate the prognostic nutritional index and histological grade in the long-term outcome of patients with GBC after radical surgery (RS).
A retrospective study of a total of 198 patients with GBC who underwent surgical treatment were enrolled. The hematological indicators, imageological data, and perioperative clinical data were acquired for statistical analysis and poor prognosis model construction.
Prognostic nutrition index (PNI) < 45.88, maximum tumor diameter (MTD) > 2.24 cm, and jaundice (JD) were all associated with a poor prognosis in multivariate logistic regression analysis. The prognosis prediction model was based on the three risk factors, which indicated a superior predictive ability in the primary cohort [area under the curve (AUC) = 0.951] and validation cohort (AUC = 0.888). In multivariate Cox regression analysis, poorly differentiation (PD) was associated with poor 3-year survival. In addition, Kaplan-Meier (KM) survival analysis suggested that GBC patients with high-risk scores and PD had a better prognosis after RS ( < 0.05), but there was no significant difference in prognosis for patients with non-poorly differentiation (NPD) or low-risk scores after RS ( > 0.05).
Our prediction model for GBC patients with prognosis evaluation is accurate and effective. For patients with PD and high-risk scores, RS is highly recommended; a simple cholecystectomy can also be considered for acceptance for patients with NPD or low-risk score. The significant findings provide a new therapeutic strategy for the clinical treatment of GBC.
胆囊癌（GBC）是胆道最常见的恶性肿瘤，5年生存率为5%。预测GBC患者预后的模型仍存在争议。因此，为构建GBC的预后预测模型，开展了一项回顾性队列研究，以探讨根治性手术（RS）后GBC患者长期预后中的预后营养指数和组织学分级。
纳入198例接受手术治疗的GBC患者进行回顾性研究。获取血液学指标、影像学数据和围手术期临床数据进行统计分析并构建预后不良模型。
在多因素逻辑回归分析中，预后营养指数（PNI）<45.88、最大肿瘤直径（MTD）>2.24 cm和黄疸（JD）均与预后不良相关。预后预测模型基于这三个危险因素，在初级队列[曲线下面积（AUC）=0.951]和验证队列（AUC = 0.888）中显示出卓越的预测能力。在多因素Cox回归分析中，低分化（PD）与3年生存率低相关。此外，Kaplan-Meier（KM）生存分析表明，高危评分和PD的GBC患者RS后预后较好（<0.05），但RS后非低分化（NPD）或低危评分患者的预后无显著差异（>0.05）。
我们用于GBC患者预后评估的预测模型准确有效。对于PD和高危评分的患者，强烈推荐行RS；对于NPD或低危评分的患者，也可考虑接受单纯胆囊切除术。这些重要发现为GBC的临床治疗提供了一种新的治疗策略。
