Abstract
BackgroundSerum lipids were reported to be the prognostic factors of various cancers, but their prognostic value in malignant biliary tumor (MBT) patients remains unclear. Thus we aim to assess and compare prognosis values of different serum lipids, and construct a novel prognostic nomogram based on serum lipids.MethodsPatients with a confirmed diagnosis of MBT at our institute from 2003 to 2017 were retrospectively reviewed. Prognosis-related factors were identified via univariate and multivariate Cox regression analyses. Then the novel prognostic nomogram and a 3-tier staging system were constructed based on these factors and further compared to the TNM staging system.ResultsA total of 368 patients were included in this study. Seven optimal survival-related factors—TC/HDL > 10.08, apolipoprotein B > 0.9 g/L, lipoprotein> 72 mg/L, lymph node metastasis, radical cure, CA199 > 37 U/mL, and tumor differentiation —were included to construct the prognostic nomogram. The C-indexes in training and validation sets were 0.738 and 0.721, respectively. Besides, ROC curves, calibration plots, and decision curve analysis all suggested favorable discrimination and predictive ability. The nomogram also performed better predictive ability than the TNM system and nomogram without lipid parameters. And the staging system based on nomogram also presented better discriminative ability than TNM system (P < 0.001).ConclusionsThe promising prognostic nomogram based on lipid parameters provided an intuitive method for performing survival prediction and facilitating individualized treatment and was a great complement to the TNM staging system in predicting overall survival.
Highlights
Serum lipids were reported to be the prognostic factors of various cancers, but their prognostic value in malignant biliary tumor (MBT) patients remains unclear
Laboratory data including hepatic parameters (including albumin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), lactate dehydrogenase (LDH), total bilirubin (TBIL)), serum lipid assessment (including total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), lowdensity lipoprotein (LDL), ratio of Total cholesterol (TC) to High-density lipoprotein (HDL) (TC/ HDL), ratio of TG to HDL (TG/HDL), apolipoprotein A-1 (ApoA1), apolipoprotein B (ApoB) and lipoprotein) and Carbohydrate antigen 199 (CA199) level were obtained at the time of diagnosis of MBT
To the best of our knowledge, this is the first research found a high level of TC/HDL, ApoB and lipoprotein were associated with poor prognosis in MBT patients
Summary
Serum lipids were reported to be the prognostic factors of various cancers, but their prognostic value in malignant biliary tumor (MBT) patients remains unclear. New prognostic factors with good predictive ability and the prognostic predictive model is needed for early risk stratification of patients’ prognosis as well as identifying potential therapeutic targets, which further facilitate early clinical intervene and individualized treatment. Prognostic prediction of MBT mostly based on the AJCC TNM staging system [6], which mainly based on surgical pathology features including tumor size, lymph node metastasis and distant metastasis, regardless of clinical and laboratory parameters. New prognostic factors with better predictive capability for BMT patients are needed
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