A Novel Staging System to Forecast the Cancer-Specific Survival of Patients With Resected Gallbladder Cancer

Yongcong Yan; Jianhong Lin; Mengyu Zhang; Haohan Liu; Qianlei Zhou; Ruibin Chen; Kai Wen; Jie Wang; Zhiyu Xiao; Kai Mao

doi:10.3389/fonc.2020.01281

A Novel Staging System to Forecast the Cancer-Specific Survival of Patients With Resected Gallbladder Cancer

Front Oncol. 2020 Jul 28:10:1281. doi: 10.3389/fonc.2020.01281. eCollection 2020.

Authors

Yongcong Yan^{1

2}, Jianhong Lin^{1

2}, Mengyu Zhang³, Haohan Liu^{1

2}, Qianlei Zhou^{1

2}, Ruibin Chen^{1

2}, Kai Wen^{1

2}, Jie Wang¹, Zhiyu Xiao¹, Kai Mao¹

Affiliations

¹ Department of Hepatobiliary Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
² Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China.
³ Department of Gastroenterology and Hepatology, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.

Abstract

Objective: Gallbladder cancer (GBC) is one of the most aggressive malignant tumors, and there is no effective and convenient method for predicting cancer-specific survival (CSS). We aim to develop a novel nomogram staging system based on the positive lymph node ratio (pLNR) for GBC patients. Methods:A total of 1,356 patients enrolled in the study. We evaluated the prognostic value of the pLNR and built a prognostic nomogram staging system based on the pLNR in the training cohort. The concordance index and calibration plots were used to evaluate model discrimination. The predictive accuracy and clinical value of the nomograms were measured by decision curve analysis (DCA). The CSS nomogram was further validated in an internal validation cohort. Results:The pLNR was an independent prognostic factor for CSS based on Cox regression analyses. A prognostic nomogram that combined T classification, pLNR, M classification, histologic grade, live metastasis, and tumor size was formulated with a c-index of 0.763 (95% CI, 0.728-0.798), while the c-indexes for the staging system of AJCC 8th, 7th, and 6th for CSS prediction were 0.718, 0.718, and 0.717, respectively. The calibration curves showed perfect agreement. The DCA showed that the nomogram provided substantial clinical value. The nomogram (the AUCs for 1, 3, and 5 years were 0.693, 0.716, and 0.726, respectively,) showed high prognostic accuracy. Conclusion:We have developed a formulated nomogram staging system based on the pLNR that allows more accurate individualized predictions of CSS for resected GBC patients than the AJCC staging systems.

Keywords: cancer-specific survival; decision curve analysis; epidemiology and end results; gallbladder cancer; nomogram; positive lymph node ratio; surveillance.