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.
Highlights
Gallbladder cancer (GBC) is an uncommon tumor with an incidence of 2.5 out of 100,000 [1, 2], accounting for ∼0.7% of all adult cancers in the USA and 1.2% in China [3, 4]
The present study shows that positive lymph node ratio (pLNR) was an independent prognostic predictor for cancer-specific survival (CSS) in resected GBC patients based on Cox univariate and multivariate analyses
The majority of independent prognostic factors of CSS in the nomogram model identified by our study, including T classification, M classification, histologic grade, and tumor size, were all independent factors according to our work, which was consistent with a number of previous studies [11, 29–31]
Summary
Gallbladder cancer (GBC) is an uncommon tumor with an incidence of 2.5 out of 100,000 [1, 2], accounting for ∼0.7% of all adult cancers in the USA and 1.2% in China [3, 4]. GBC is a highly fatal disease with a median survival of ∼6 months, while the 5-year survival rate is only 5% [6–8] because it is often diagnosed late in the process when the tumors are already large enough to cause obstruction and invade nearby structures. Mitin et al [9] reported that adjuvant chemoradiation improves the survival of GBC-resected patients, except for those diagnosed with stage T1N0 disease. Kasumova et al [10] proposed that adjuvant chemotherapy with or without radiation provides prolonged survival after the resection of T2/T3 tumors. An accurate GBC staging system is necessary to guide the subsequent therapeutic strategy for patients who have undergone radical surgery
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