Development and external validation of a nomogram for predicting the effect of tumor size on cancer-specific survival of resected gallbladder cancer: a population-based study

Yaodong Zhang,Ziyi Wang,Tao Zhou,Changxian Li,Wangjie Jiang,Jiang Chang,Xiangcheng Li,Sheng Han

doi:10.1007/s10147-021-01891-2

Yaodong Zhang, Ziyi Wang + Show 6 more

Open Access

https://doi.org/10.1007/s10147-021-01891-2

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Abstract

The impact of tumor size on account of the long-term survival results in gallbladder cancer (GBC) patients has been controversial. It is urgent necessary to identify the optimal cut-off value of tumor size in resected GBC, and we attempted to integrate tumor size with other prognostic factors into a prognostic nomogram to predict the cancer-specific survival (CSS) of GBC patients. 1639 patients with resected GBC were extracted from the Surveillance, Epidemiology and End Results (SEER) database. X-tile program was used to identify the optimal cut-off value of tumor size. A nomogram including tumor size was established to predict 1-, 3- and 5-year CSS based on the independent risk factors chosen by univariate and multivariable cox analyses. The precision of the nomogram for predicting survival was validated with Harrell's concordance index (C-index), calibration curves, and receiver operating characteristic curve (ROC) internally and externally. Patients with GBC were classified into 1-13mm, 14-63mm and 64mm subgroup based on the optimal cut-off for tumor size in terms of CSS. The nomogram according to the independent factors was well calibrated and displayed better discrimination power than 7th tumor-node-metastasis (TNM) stage systems. The results demonstrated that increased tumor size is closely associated with the worse CSS. Our novel nomogram, which outperforms the conventional TNM staging system, showed satisfactory accuracy and clinically practicality for predicting the outcome of resected GBC patients.

Highlights

Gallbladder carcinoma (GBC) is a rare, lethal malignancy characterized by its vague symptoms at initial stage, less than one-third of patients presenting are eligible for curative-intent surgical resection and only 16% patients with gallbladder cancer (GBC) will survive for more than five years[1,2,3,4]
Patients with GBC were classified into 1–13 mm, 14–63 mm and 64 mm subgroup based on the optimal cutoff for tumor size in terms of cancer-specific survival (CSS)
The nomogram according to the independent factors was well calibrated and displayed better discrimination power than 7th Tumor-Node-Metastasis (TNM) stage systems

Summary

Introduction

Gallbladder carcinoma (GBC) is a rare, lethal malignancy characterized by its vague symptoms at initial stage, less than one-third of patients presenting are eligible for curative-intent surgical resection and only 16% patients with GBC will survive for more than five years[1,2,3,4]. Unlike lymph node metastasis and liver invasion, which have been recognized as the independent prognostic factors in GBC, the impact of tumor size on the long-term survival results in GBC patients, especially those who underwent resection, has remained a controversial debate in worldwide. The recent studies, which proposed prognostic nomograms/systems, pointed out that patient and tumor-related factors are closely associated with prognosis of GBC patients[7,8]. The optimal cutoff value of tumor size for predicting prognosis of GBC is still controversial. The impact of tumor size on account of the long-term survival results in gallbladder cancer (GBC) patients has been controversial. It is urgent necessary to identify the optimal cutoff value of tumor size in resected GBC, and we attempted to integrate tumor size with other prognostic factors into a prognostic nomogram to predict the cancer-specific survival (CSS) of GBC patients

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