A Novel Prognostic Nomogram for Gallbladder Cancer after Surgical Resection: A Single-Center Experience

Zuyi Ma; Fengying Dong; Zhenchong Li; Zehao Zheng; Zixuan Zhou; Hongkai Zhuang; Chunsheng Liu; Bowen Huang; Shanzhou Huang; Yiping Zou; LinLing Yang; Yuanfeng Gong; Chuanzhao Zhang; Baohua Hou

doi:10.1155/2021/6619149

A Novel Prognostic Nomogram for Gallbladder Cancer after Surgical Resection: A Single-Center Experience

J Oncol. 2021 Feb 8:2021:6619149. doi: 10.1155/2021/6619149. eCollection 2021.

Authors

Zuyi Ma^{1

2}, Fengying Dong³, Zhenchong Li², Zehao Zheng^{1

2}, Zixuan Zhou², Hongkai Zhuang^{1

2}, Chunsheng Liu^{1

2}, Bowen Huang⁴, Shanzhou Huang², Yiping Zou^{1

2}, LinLing Yang⁵, Yuanfeng Gong^{2

6}, Chuanzhao Zhang², Baohua Hou²

Affiliations

¹ Shantou University of Medical College, Shantou 515000, China.
² Department of General Surgery, Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou 510080, China.
³ Forth Department of Geriatrics, General Hospital of Southern Theater Command, PLA, Guangzhou 510080, China.
⁴ Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China.
⁵ Guangzhou Medical University, Guangzhou 511436, China.
⁶ Department of Hepatobiliary Surgery, The Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou 510095, China.

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.