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BackgroundGallbladder carcinoma (GBC) is a biliary tract tumor with a high mortality rate. The objectives of this study were to explore the risk factors of GBC in patients with gallstones and to establish effective screening indicators.MethodsA total of 588 patients from medical centers in two different regions of China were included in this study and defined as the internal test samples and the external validation samples, respectively. We retrospectively reviewed the differences in clinicopathologic data of the internal test samples to find the independent risk factors that affect the occurrence of GBC. Then, we constructed three different combined predictive factors (CPFs) through the weighting method, integral system, and nomogram, respectively, and named them CPF-A, CPF-B, and CPF-C sequentially. Furthermore, we evaluated these indicators through calibration and DCA curves. The ROC curve was used to analyze their diagnostic efficiency. Finally, their diagnostic capabilities were validated in the external validation samples.ResultsIn the internal test samples, the results showed that five factors, namely, age (RR = 3.077, 95% CI: 1.731-5.496), size of gallstones (RR = 13.732, 95% CI: 5.937-31.762), course of gallstones (RR = 2.438, 95% CI: 1.350-4.403), CEA (RR = 9.464, 95% CI: 3.394-26.392), and CA199 (RR = 9.605, 95% CI: 4.512-20.446), were independent risk factors for GBC in patients with gallstones. Then, we established three predictive indicators: CPF-A, CPF-B, and CPF-C. These models were further validated using bootstrapping with 1,000 repetitions. Calibration and decision curve analysis showed that the three models fit well. Meanwhile, multivariate analysis showed that CPF-B and CPF-C were independent risk factors for GBC in patients with gallstones. In addition, the validation results of the external validation samples are essentially consistent with the internal test samples.ConclusionAge (≤58.5 vs. >58.5 years), size of gallstones (≤1.95 vs. >1.95cm), course of gallstones (≤10 vs. >10 years), CEA (≤5 vs. >5 ng/ml), and CA199 (≤37 vs. >37 U/ml) are independent risk factors for GBC in patients with gallstones. When positive indicators were ≥2 among the five independent risk factors or the score of the nomogram was >82.64, the risk of GBC was high in gallstone patients.

Objective: To investigate the impacts of tumor location on the prognosis of patients with T1-3N0-1M0 gallbladder carcinoma(GBC) after radical surgery.Methods: Totally, 136 patients with stage T1-3 gallbladder carcinoma after radical surgery from 2000 to 2018 were enrolled and divided into two groups according to anatomic location of GBC (neck /body and fundus). The clinicopathological features and survival time were compared between these two groups. At last, in combination with the difference between the liver side and the peritoneal side of the tumor, survival analysis and multivariable Cox-proportional hazards regression models were performed in GBC patients with survival differences between gallbladder neck and body/fundus tumors.Results: The bile duct invasion, lymph node metastasis, tumor growth pattern, jaundice, albumin, and tumor markers were significantly related to the tumors in neck of gallbladder(P<0.05). Besides, patients with GBC in body and fundus of gallbladder had a higher rate of appearing microscopic liver metastasis(P<0.05). Survival analysis showed that there was significant difference on patients with stage T2 GBC in different tumor location (neck /body and fundus), but no significant difference on stage T1 and T3. Further combining the differences between the liver side and the peritoneal side of the tumor, tumor location, lymph node metastasis, bile duct invasion, microscopic liver metastasis, tumor differentiation, and jaundice were deemed as prognostic factors according to univariable survival analysis. Among these factors, multivariable Cox analysis showed that lymph node metastasis and tumor location were independent prognostic factors for survival of patients with T2 GBC (P <0.05).Conclusions: Tumor location is an important prognostic factor for GBC, especially for the patients with T2 stage. Besides the survival differences between the hepatic-side and peritoneal-side tumors, tumor in neck is also one of the factors predicting the poor prognosis at T2 stage. GBC in neck was more prone to cause bile duct invasion, lymph node metastasis and jaundice. However, tumors in body and fundus were more likely to appear microscopic liver metastasis. Further refinement of the surgery for T2 GBC according to the tumor location may improve their survival time.