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

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.

The Significance of Tumor Budding and Immunohistochemical Axl Expression in Gallbladder Adenocarcinomas

“…Therefore, resection margin positivity is a common histopathological finding in GBC since they cannot be operated curatively. The ratio of resection margin 1 patients is 36.8% and is compatible with the literature 1 , 6 , 7 , 35 . The statistically significant distinction in the short overall survival time in this group of patients underlines the need for a complete resection during the operation.…”

“…The light of the literature shows that GBC’s prognostic characteristics have been almost the same for many years 1 , 3 , 4 , 7 , 35 . Tumor size, pT staging, lymph node metastasis, perineural invasion, histological grading, RM, and liver invasion play decisive roles in the prognosis of GBC patients 1 , 4 , 6 , 7 , 35 . The present study found that the relationship between poor tumor differentiation, advanced pT, positive resection margin, the presence of perineural invasion, lymphovascular invasion, and serosal invasion with a short OS time is in agreement with the literature 1 , 3 , 6 , 7 .…”

“…Tumor size, pT staging, lymph node metastasis, perineural invasion, histological grading, RM, and liver invasion play decisive roles in the prognosis of GBC patients 1 , 4 , 6 , 7 , 35 . The present study found that the relationship between poor tumor differentiation, advanced pT, positive resection margin, the presence of perineural invasion, lymphovascular invasion, and serosal invasion with a short OS time is in agreement with the literature 1 , 3 , 6 , 7 . If we first reassess the prognostic features of the group again in the light of the literature, it would be appropriate to talk about resection margin, which is one of the accepted prognostic features, and then TIL and TB as the current features.…”

“…The probable reason for this is that it spreads to the other organs via lymph, perineural, and blood vessels or directly to the liver at an early stage 5 . The histopathological subtype, tumor size, differentiation, perineural and lymphovascular invasion, regional lymph node metastases, and surgical margins are known as the main prognostic features for today 1 , 4 , 6 , 7 . Mesenchymal-like cancer cells are known to play a decisive role in chemotherapy resistance and the metastatic stage of malignant neoplasms 8 , 9 .…”

A novel nomogram based on log odds of positive lymph nodes to predict survival for non-metastatic gallbladder adenocarcinoma after surgery

“…Nomograms, incorporating and illustrating important prognostic factors in a visible way, have become a superior methods to accurately predict outcomes for patients with various cancers 7 , 8 . Previously, researchers have attempted to construct nomograms to predict the prognosis of patients with GBA 9 , 10 . Some novel LN schemes, such as lymph node ratio (LNR) and log odds of positive lymph node (LODDS), showed more accurate predictive ability than AJCC N status 11 – 13 .…”