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Patkar S, Kunte A, Varty GP, Ramaswamy A, Bhargava P, Ostwal V, Goel M. Comparison of age-stratified survival outcomes of gallbladder cancers in an Indian population. HPB (Oxford) 2024; 26:1155-1163. [PMID: 38834414 DOI: 10.1016/j.hpb.2024.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/15/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
BACKGROUND Gallbladder cancers (GBCs) occur a decade earlier in India in comparison to the global occurrence, limiting the applicability of existing literature on age adjusted outcomes. METHODS Patients who underwent surgery between 01.01.2010 and 31.12.2020 for GBC were analyzed. Patients were divided into three age groups: group 1(≤40 years), group 2(41-60 years), group 3(>60 years) and their outcomes were compared. RESULTS Total of 6190 patients were treated for suspected or diagnosed GBC with a median age of 57 years. Curative resection was performed in 749 (67.9%) patients, of whom 114 (16.2%), 471 (62.9%), and 164 (21.9%) patients were in groups 1, 2, and 3, respectively. 5-year disease-free survival (DFS) [46.8% vs. 58.5%, p = 0.031] and overall survival (OS)[53.5% vs. 66.6%, p = 0.05] of group 3 were significantly lower than group 1. Patient age (HR 1.021), AJCC stage (HR 6.413), pathologic residual disease in the gallbladder fossa (HR 2.44), and extranodal tumor deposits (HR 1.762) were identified as independent predictors of poor OS. CONCLUSIONS Gallbladder cancers in the Indian population show poorer outcomes with advancing age. Higher proportion of males in the elderly group with a more advanced stage at presentation are plausible reasons for poorer outcomes.
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Affiliation(s)
- Shraddha Patkar
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Aditya Kunte
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Gurudutt P Varty
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anant Ramaswamy
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Prabhat Bhargava
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Vikas Ostwal
- Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mahesh Goel
- Department of Gastrointestinal and Hepatobiliary Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India.
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Yan Z, Zhang W, Sun K. TREM1 is involved in the mechanism between asthma and lung cancer by regulating the Toll‑like receptor signaling pathway. Oncol Lett 2024; 27:16. [PMID: 38028174 PMCID: PMC10664071 DOI: 10.3892/ol.2023.14149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 06/09/2023] [Indexed: 12/01/2023] Open
Abstract
Lung cancer and asthma are both global health problems with significant economic consequences. Recent studies have demonstrated that asthma may be a risk factor for lung cancer. The present study aimed to explore the pathogenesis between these two diseases through a comprehensive analysis. Differentially expressed genes (DEGs) screened in the asthma-related GSE165934 dataset were analyzed to find relevant inflammatory pathways. Overlapping genes regulated by inflammatory pathways and lung cancer-DEGs from The Cancer Genome Atlas (TCGA) were obtained and subjected to survival and gene-wide mutation analyses, and nomogram construction to determine the hub gene. The hub gene was further analyzed through expression validation, immunoassays and functional experiments to investigate its role and mechanism in lung cancer. Functional enrichment analysis showed that 1,275 DEGs from GSE165934 were closely associated with the Toll-like receptor signaling pathway, and 8 overlapping genes were identified from 12 genes regulated by the Toll-like receptor signaling pathway and 3,134 TCGA-DEGs. After a series of bioinformatics analyses, it was found that triggering receptor expressed on myeloid cells 1 (TREM1) was the hub gene involved in the mechanism of asthma and lung cancer. TREM1 was also found to be a suppressor gene in lung cancer correlated with immune cells, immune checkpoint-related genes and tumor mutational burden score. Additionally, the results of Cell Counting Kit-8 and Transwell experiments demonstrated that overexpression of TREM1 could significantly inhibit the invasion, proliferation and migration of lung cancer cells. Reverse transcription-quantitative PCR and western blotting demonstrated that the overexpression of TREM1 could also significantly reduce the level of Toll-like receptor signaling pathway proteins. The present findings suggest that TREM1 is associated with the mechanism of asthma and lung cancer through its regulation of the Toll-like receptor signaling pathway. Furthermore, TREM1 may serve as a potential treatment target and prognostic indicator for patients with lung cancer.
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Affiliation(s)
- Zhulin Yan
- Department of Emergency Medicine, Minhang Hospital, Fudan University, Shanghai 201100, P.R. China
| | - Wei Zhang
- Department of Emergency Medicine, Minhang Hospital, Fudan University, Shanghai 201100, P.R. China
| | - Keyu Sun
- Department of Emergency Medicine, Minhang Hospital, Fudan University, Shanghai 201100, P.R. China
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3
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Chen J, Han Y. Development and validation of an online dynamic prognostic nomogram for incidental gallbladder adenocarcinoma patients without distant metastasis after surgery: a population-based study. Front Med (Lausanne) 2023; 10:1175211. [PMID: 38020083 PMCID: PMC10667698 DOI: 10.3389/fmed.2023.1175211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Gallbladder cancer is the most common malignant tumor of the biliary system, most of which is adenocarcinoma. Our study explored developing and validating a nomogram to predict overall and cancer-specific survival probabilities internally and externally for incidental gallbladder adenocarcinoma patients without distant metastasis after surgery. Methods Patients screened and filtered in the Surveillance, Epidemiology, and End Results (SEER) database, whose years of diagnosis between 2010 and 2015 were collected as a derivation cohort, while those between 2016 and 2019 were a temporal validation cohort. Overall survival (OS) and cancer-specific survival (CSS) were chosen as the primary and secondary endpoints of the retrospective study cohort. Potential clinical variables were selected for a Cox regression model analysis by performing both-direction stepwise selection to confirm the final variables. The performance of final nomograms was evaluated by Harrell's C statistic and Brier score, with a graphical receptor operating characteristic (ROC) curve and calibration curve. Results Seven variables of age, race, tumor size, histologic grade, T stage, regional lymph nodes removed, and positive regional lymph nodes were finally determined for the OS nomogram; sex had also been added to the CSS nomogram. Novel dynamic nomograms were established to predict the prognosis of incidental gallbladder adenocarcinoma patients without distant metastasis after surgery. The ROC curve demonstrated good accuracy in predicting 1-, 3-, and 5-year OS and CSS in both derivation and validation cohorts. Correspondingly, the calibration curve presented perfect reliability between the death or cancer-specific death probability and observed death or cancer-specific death proportion in both derivation and validation cohorts. Conclusion Our study established novel dynamic nomograms based on seven and eight clinical variables separately to predict OS and CSS of incidental gallbladder adenocarcinoma patients without distant metastasis after surgery, which might assist doctors in advising and guiding therapeutic strategies for postoperative gallbladder adenocarcinoma patients in the future.
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Affiliation(s)
- Jie Chen
- Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
| | - Yehong Han
- Department of General Surgery, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China
- Department of General Surgery, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou, China
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4
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Yang J, Lv L, Zhao F, Mei X, Zhou H, Yu F. The value of the preoperative Naples prognostic score in predicting prognosis in gallbladder cancer surgery patients. World J Surg Oncol 2023; 21:303. [PMID: 37743468 PMCID: PMC10519127 DOI: 10.1186/s12957-023-03198-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 09/19/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE The Naples prognostic score (NPS) is a comprehensive prognostic model that includes inflammatory and nutrition-related indicators and is increasingly used as a prognostic score for various malignant tumors. Given its predictive effect on prognosis in patients with gallbladder cancer, it is currently unclear. This study aimed to investigate the role of preoperative NPS in predicting prognosis in gallbladder cancer surgery patients. PATIENTS AND METHODS A retrospective analysis was performed for 135 patients who underwent radical surgery for gallbladder cancer without preoperative treatment between March 2011 and January 2020. NPS was calculated by measuring the preoperative total cholesterol value, serum albumin value, neutrophil-lymphocyte ratio (NLR), and lymphocyte-monocyte ratio (LMR). They were then divided into 3 groups (groups 0, 1, and 2) based on NPS scores. Survival analysis was performed using the Kaplan-Meier method and log-rank test. Univariate and multivariate Cox proportional hazards models were used to identify independent prognostic factors. Plot time-dependent receiver operating characteristic (ROC) curves to compare the prognostic value of scoring systems. Finally, a nomogram model was developed with independent prognostic factors. RESULTS Multivariate analysis showed that NPS was an independent risk factor affecting OS (HR = 3.417, p < 0.05). The time-dependent ROC curve results showed that NPS had a better predictive value on survival prognosis than other indicators. The nomogram constructed according to independent factors such as NPS has a good predictive ability for OS. CONCLUSION As a simple and reliable tool, the NPS has important predictive value in the survival prognosis of gallbladder cancer patients. The nomogram model constructed by NPS will help determine prognosis and make individualized treatment decisions.
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Affiliation(s)
- Jie Yang
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Lin Lv
- Department of Health Management Center, First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Fengqing Zhao
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Xiaoping Mei
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Hongkun Zhou
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China
| | - Feijie Yu
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jiaxing, Affiliated Hospital of Jiaxing University, Jiaxing, 314000, Zhejiang, China.
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Yin Z, Chen T, Shu Y, Li Q, Yuan Z, Zhang Y, Xu X, Liu Y. A Gallbladder Cancer Survival Prediction Model Based on Multimodal Fusion Analysis. Dig Dis Sci 2023; 68:1762-1776. [PMID: 36496528 PMCID: PMC10133088 DOI: 10.1007/s10620-022-07782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/28/2022] [Indexed: 04/27/2023]
Abstract
BACKGROUND Gallbladder cancer is the sixth most common malignant gastrointestinal tumor. Radical surgery is currently the only effective treatment, but patient prognosis is poor, with a 5-year survival rate of only 5-10%. Establishing an effective survival prediction model for gallbladder cancer patients is crucial for disease status assessment, early intervention, and individualized treatment approaches. The existing gallbladder cancer survival prediction model uses clinical data-radiotherapy and chemotherapy, pathology, and surgical scope-but fails to utilize laboratory examination and imaging data, limiting its prediction accuracy and preventing sufficient treatment plan guidance. AIMS The aim of this work is to propose an accurate survival prediction model, based on the deep learning 3D-DenseNet network, integrated with multimodal medical data (enhanced CT imaging, laboratory test results, and data regarding systemic treatments). METHODS Data were collected from 195 gallbladder cancer patients at two large tertiary hospitals in Shanghai. The 3D-DenseNet network extracted deep imaging features and constructed prognostic factors, from which a multimodal survival prediction model was established, based on the Cox regression model and incorporating patients' laboratory test and systemic treatment data. RESULTS The model had a C-index of 0.787 in predicting patients' survival rate. Moreover, the area under the curve (AUC) of predicting patients' 1-, 3-, and 5-year survival rates reached 0.827, 0.865, and 0.926, respectively. CONCLUSIONS Compared with the monomodal model based on deep imaging features and the tumor-node-metastasis (TNM) staging system-widely used in clinical practice-our model's prediction accuracy was greatly improved, aiding the prognostic assessment of gallbladder cancer patients.
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Affiliation(s)
- Ziming Yin
- School of Health Science and Engineering, University of Shanghai for Science and Technology, 516 Jungong Road, Yangpu District, Shanghai, 200093, China.
| | - Tao Chen
- Department of Biliary and Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Yijun Shu
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China
- Shanghai Key Laboratory of Biliary Disease Research, Institute of Biliary Tract Disease Research, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China
| | - Qiwei Li
- Department of Biliary and Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Zhiqing Yuan
- Department of Biliary and Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Yijue Zhang
- Department of Anesthesiology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Xinsen Xu
- Department of Biliary and Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
| | - Yingbin Liu
- Department of Biliary and Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
- Shanghai Key Laboratory of Biliary Disease Research, Institute of Biliary Tract Disease Research, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Yangpu District, Shanghai, 200092, China
- State Key Laboratory of Oncogenes and Related Genes, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine, 160 Pujian Road, Pudong New District, Shanghai, 200127, China
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de Savornin Lohman EAJ, de Bitter TJJ, Hannink G, Wietsma MFT, Vink-Borger E, Nagtegaal ID, Hugh TJ, Gill AJ, Bhimani N, Ahadi MS, van der Post RS, de Reuver PR. Development and External Validation of a Model to Predict Overall Survival in Patients With Resected Gallbladder Cancer. Ann Surg 2023; 277:e856-e863. [PMID: 34387199 DOI: 10.1097/sla.0000000000005154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to develop and validate a clinical prediction model to predict overall survival in patients with nonmetastatic, resected gallbladder cancer (GBC). BACKGROUND Although several tools are available, no optimal method has been identified to assess survival in patients with resected GBC. METHODS Data from a Dutch, nation-wide cohort of patients with resected GBC was used to develop a prediction model for overall survival. The model was internally validated and a cohort of Australian GBC patients who underwent resection was used for external validation. The performance of the American Joint Committee on Cancer (AJCC) staging system and the present model were compared. RESULTS In total, 446 patients were included; 380 patients in the development cohort and 66 patients in the validation cohort. In the development cohort median survival was 22 months (median follow-up 75 months). Age, T/N classification, resection margin, differentiation grade, and vascular invasion were independent predictors of survival. The externally validated C-index was 0.75 (95%CI: 0.69-0.80), implying good discriminatory capacity. The discriminative ability of the present model after internal validation was superior to the ability of the AJCC staging system (Harrell C-index 0.71, [95%CI: 0.69-0.72) vs. 0.59 (95% CI: 0.57-0.60)]. CONCLUSION The proposed model for the prediction of overall survival in patients with resected GBC demonstrates good discriminatory capacity, reasonable calibration and outperforms the authoritative AJCC staging system. This model can be a useful tool for physicians and patients to obtain information about survival after resection and is available from https:// gallbladderresearch.shinyapps.io/Predict_GBC_survival/.
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Affiliation(s)
- Elise A J de Savornin Lohman
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgery, Nijmegen, The Netherlands
- Department of Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - T J J de Bitter
- Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Department of Pathology, Nijmegen, The Netherlands
| | - G Hannink
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Operating Rooms, Nijmegen, The Netherlands
| | - M F T Wietsma
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgery, Nijmegen, The Netherlands
| | - E Vink-Borger
- Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Department of Pathology, Nijmegen, The Netherlands
| | - I D Nagtegaal
- Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Department of Pathology, Nijmegen, The Netherlands
| | - T J Hugh
- Royal North Shore Hospital, Upper GI Surgical Unit, University of Sydney, Australia
| | - A J Gill
- University of Sydney, Sydney, New South Wales, Australia
| | - N Bhimani
- Royal North Shore Hospital, Upper GI Surgical Unit, University of Sydney, Australia
| | - M Seyed Ahadi
- Royal North Shore Hospital, Upper GI Surgical Unit, University of Sydney, Australia
| | - R S van der Post
- Radboud University Medical Center, Radboud Institute of Molecular Life Sciences, Department of Pathology, Nijmegen, The Netherlands
| | - Philip R de Reuver
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Surgery, Nijmegen, The Netherlands
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Xie ZH, Shi X, Liu MQ, Wang J, Yu Y, Zhang JX, Chu KJ, Li W, Ge RL, Cheng QB, Jiang XQ. Development and validation of a nomogram to predict overall survival in patients with incidental gallbladder cancer: A retrospective cohort study. Front Oncol 2023; 12:1007374. [PMID: 36761430 PMCID: PMC9902907 DOI: 10.3389/fonc.2022.1007374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/28/2022] [Indexed: 01/25/2023] Open
Abstract
Objective The aim of this study was to develop and validate a nomogram to predict the overall survival of incidental gallbladder cancer. Methods A total of 383 eligible patients with incidental gallbladder cancer diagnosed in Shanghai Eastern Hepatobiliary Surgery Hospital from 2011 to 2021 were retrospectively included. They were randomly divided into a training cohort (70%) and a validation cohort (30%). Univariate and multivariate analyses and the Akaike information criterion were used to identify variables independently associated with overall survival. A Cox proportional hazards model was used to construct the nomogram. The C-index, area under time-dependent receiver operating characteristic curves and calibration curves were used to evaluate the discrimination and calibration of the nomogram. Results T stage, N metastasis, peritoneal metastasis, reresection and histology were independent prognostic factors for overall survival. Based on these predictors, a nomogram was successfully established. The C-index of the nomogram in the training cohort and validation cohort was 0.76 and 0.814, respectively. The AUCs of the nomogram in the training cohort were 0.8, 0.819 and 0.815 for predicting OS at 1, 3 and 5 years, respectively, while the AUCs of the nomogram in the validation cohort were 0.846, 0.845 and 0.902 for predicting OS at 1, 3 and 5 years, respectively. Compared with the 8th AJCC staging system, the AUCs of the nomogram in the present study showed a better discriminative ability. Calibration curves for the training and validation cohorts showed excellent agreement between the predicted and observed outcomes at 1, 3 and 5 years. Conclusions The nomogram in this study showed excellent discrimination and calibration in predicting overall survival in patients with incidental gallbladder cancer. It is useful for physicians to obtain accurate long-term survival information and to help them make optimal treatment and follow-up decisions.
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Affiliation(s)
- Zhi-Hua Xie
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Xuebing Shi
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Ming-Qi Liu
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Jinghan Wang
- Department of Hepatopancreatobiliary Surgery, East Hospital, Tongji University, Shanghai, China
| | - Yong Yu
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Ji-Xiang Zhang
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Kai-Jian Chu
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Wei Li
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Rui-Liang Ge
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Qing-Bao Cheng
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China,*Correspondenc: Xiao-Qing Jiang, ; Qing-Bao Cheng,
| | - Xiao-Qing Jiang
- Department I of Biliary Tract Surgery, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China,*Correspondenc: Xiao-Qing Jiang, ; Qing-Bao Cheng,
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8
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Fang C, Li W, Wang Q, Wang R, Dong H, Chen J, Chen Y. Risk factors and prognosis of liver metastasis in gallbladder cancer patients: A SEER-based study. Front Surg 2022; 9:899896. [PMID: 36081582 PMCID: PMC9445213 DOI: 10.3389/fsurg.2022.899896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
Background Liver metastasis is a common complication in gallbladder cancer (GBC). We design this study to develop models for predicting the development of liver metastasis in GBC patients and evaluate the risk of mortality in these patients with liver metastasis. Methods GBC patients from Surveillance Epidemiology and End Results (SEER) between 2010 and 2016 were included in this study. Logistic regression was performed to discover risk factors and construct predictive models for liver metastasis in GBC patients. Cox regression was utilized to find risk factors of mortality in GBC patients with liver metastasis. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the performance of the constructed predictive models. Results Multivariate logistic regression confirmed that T stage, N stage, and tumor grade were risk factors for liver metastasis in GBC patients. Composed of these factors, the model for predicting the development of liver metastasis had AUCs of 0.707 and 0.657 in the training cohort and testing cohort, respectively. Multivariate Cox regression showed that surgery of the primary site and chemotherapy were independently associated with the mortality of GBC patients with liver metastasis. Composed of these two factors, the predictive model for 1-year mortality of GBC patients with liver metastasis had AUCs of 0.734 and 0.776 in the training cohort and testing cohort, respectively. Conclusion The predictive models that we constructed are helpful for surgeons to evaluate the risk of liver metastasis in GBC patients and the survival condition of those with liver metastasis. Surgery of the primary site and chemotherapy should be provided for GBC with liver metastasis.
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Affiliation(s)
- Cheng Fang
- Department of Hepatic Surgery IV, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Wenhui Li
- Department of Gynecology and Obstetrics, Changhai Hospital, Second Military Medical University, Shanghai, China
| | - Qingqiang Wang
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xian, China
| | - Ruoran Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Hui Dong
- International Cooperation Laboratory on Signal Transduction, National Center for Liver Cancer, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Junjie Chen
- Department of Ultrasonography, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China
| | - Yong Chen
- Department of Hepatobiliary Surgery, Xijing Hospital, Fourth Military Medical University, Xian, China
- Correspondence: Yong Chen
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Zheng BH, Zhang C, Wan WZ, Sun WT, Cheng X, Ni XJ, Ni XL, Suo T, Liu H, Shen S, Liu HB. The clinical and prognostic factors for biliary neuroendocrine neoplasm: a study based on the SEER database. BMC Surg 2022; 22:253. [PMID: 35768809 PMCID: PMC9245279 DOI: 10.1186/s12893-022-01689-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background In this study, we aimed at elucidating the postoperative survival and prognostic factors in patients with biliary neuroendocrine neoplasm (NEN). Methods Cases of biliary system NEN and adenocarcinoma from 1975 to 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A propensity score matching (PSM) method was used to adjust baseline differences in clinicopathological characteristics in our analysis. The Kaplan–Meier analysis was carried out for survival analysis. Results A total of 233 patients with biliary system NEN were enrolled in this study, of which 119 patients’ lesions located in gallbladder, while the others’ located in bile duct. The postoperative overall survival of bile duct NEN is significantly longer than that of gallbladder NEN (P < 0.001). For gallbladder NENs, surgery method (P = 0.020) and lymph node metastasis (P = 0.018) were identified as independent prognostic factors. In terms of ampulla of vater (AOV) NENs, age (P = 0.017) and lymph node metastasis (P = 0.006) were identified as independent prognostic factors, while grade (P = 0.002) and lymph node metastasis (P = 0.036) were identified as independent prognostic factors for extrahepatic bile duct (EBD) NENs. PSM analysis indicated that patients with biliary duct NENs have a better postoperative prognosis than biliary duct adenocarcinoma. Conclusions Patients with NEN have better overall survival than patients with adenocarcinoma. Gallbladder NEN has an adverse prognosis than that of biliary tract NEN. The pathological subtype, differentiation, lymph node metastasis, surgery method, and lymph node resection could affect the postoperative prognosis of the gallbladder and biliary tract NEN. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01689-7.
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Affiliation(s)
- Bo-Hao Zheng
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Cheng Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Wen-Ze Wan
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Wen-Tao Sun
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Xi Cheng
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Xiao-Jian Ni
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Xiao-Ling Ni
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Tao Suo
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Han Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Sheng Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China. .,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China.
| | - Hou-Bao Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China. .,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China. .,Department of General Surgery, Biliary Tract Disease Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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10
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Wang W, Yang CX, Yu XZ, Zhang SL, Wang J, Wang J. Clinicopathological characteristics and prognostic factors of patients with primary gallbladder neuroendocrine carcinomas. J Dig Dis 2022; 23:166-173. [PMID: 35187836 DOI: 10.1111/1751-2980.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/30/2022] [Accepted: 02/14/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Primary gallbladder neuroendocrine carcinomas (GB-NEC) are malignant neoplasms that remained to be studied. In this study we aimed to summarize their clinicopathological characteristics, effective treatment and prognostic factors for patients with GB-NEC. METHODS Patients with GB-NEC admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital and Renji Hospital, School of Medicine, Shanghai Jiao Tong University from October 2012 to August 2020 were enrolled. Clinicopathological characteristics of our patients and those reported in previous studies were recorded. The Kaplan-Meier method and univariate and multivariate Cox regression analyses were used for survival analysis. RESULTS Altogether 15 patients from our hospitals and 47 patients from previous studies were included. A total of 55 patients who underwent surgical resection, including R0 and non-R0 resection, had significantly longer overall survival compared with the other seven patients. A univariate analysis indicated that patients aged 60 years or older, with jaundice, carcinoid syndrome, non-R0 resection, and advanced stage were associated with worse survival. A multivariate analysis showed that patients aged 60 years or older, carcinoid syndrome and non-R0 resection, but not lymphadenectomy and adjuvant chemotherapy, were independently related to reduced survival. CONCLUSIONS R0 resection should be the first-line treatment for GB-NEC. Older age, carcinoid syndrome and non-R0 resection are independently associated with reduced survival after surgical resection.
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Affiliation(s)
- Wei Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuan Xin Yang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xin Zhe Yu
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shi Lei Zhang
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jian Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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11
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Zhu J, Wu Y, Xiao W, Li Y. Survival Predictors of Resectable Gallbladder Carcinoma: An Analysis of the Surveillance, Epidemiology, and End Results Database. Am Surg 2022:31348221074238. [PMID: 35061561 DOI: 10.1177/00031348221074238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background To analyze population-level data for resectable gallbladder carcinoma (GBC) according to the eighth edition of the American Joint Committee on Cancer staging system. Methods We queried the Surveillance, Epidemiology, and End Results database to identify all patients aged 18 years or older with T1-3 M0 GBC diagnosed between 2004 and 2015. Multivariate cox hazard regression analysis was used to identify prognostic factors of cancer-specific survival (CSS). Results Of the 1601 eligible patients, 1310 (81.8%) underwent cholecystectomy only and 291 (18.2%) underwent an en bloc resection. Overall, 219 (13.7%) patients were in stage I, 400 (25%) were in stage II, 260 (16.2%) were in stage IIIA, 653 (40.8%) were in stage IIIB, and 69 (4.3%) were in stage IVB. The 5-year survival rates for patients were 82.7% for stage I, 73.4% for stage II, 31.9% for stage IIIA, 24.1% for stage IIIB, and 10% for stage IVB. Multivariate cox analysis indicated that predictors of decreased CSS included age at diagnosis >65 years, tumor size >3.2 cm, adenocarcinoma, increasing tumor spread, and lymph node involvement. Besides, chemotherapy and radiation were predictors of increased CSS. Conclusions Older age, increasing tumor size, adenocarcinoma, and advanced tumor/node stage were associated with a poorer prognosis after resection for GBC. Furthermore, patients with resectable GBC can benefit from adjuvant therapy.
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Affiliation(s)
- Jisheng Zhu
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yunxiang Wu
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Weidong Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Li
- Department of General Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, China
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12
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Okumura K, Gogna S, Gachabayov M, Felsenreich DM, McGuirk M, Rojas A, Quintero L, Seshadri R, Gu K, Dong XD. Gallbladder cancer: Historical treatment and new management options. World J Gastrointest Oncol 2021; 13:1317-1335. [PMID: 34721769 PMCID: PMC8529935 DOI: 10.4251/wjgo.v13.i10.1317] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 06/19/2021] [Accepted: 09/03/2021] [Indexed: 02/06/2023] Open
Abstract
Gallbladder cancer is a rare, aggressive malignancy that has a poor overall prognosis. Effective treatment consists of early detection and surgical treatment. With the wide spread treatment of gallbladder disease with minimally invasive techniques, the rate of incidental gallbladder cancer has seen an equitable rise along with stage migration towards earlier disease. Although the treatment remains mostly surgical, newer modalities such as regional therapy as well as directed therapy based on molecular medicine has led to improved outcomes in patients with advanced disease. We aim to summarize the management of gallbladder cancer along with the newer developments in this formidable disease process.
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Affiliation(s)
- Kenji Okumura
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Shekhar Gogna
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | | | - Matthew McGuirk
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Aram Rojas
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, United States
| | - Luis Quintero
- Department of Surgery, New York Medical College, Valhalla, NY 10595, United States
| | - Ramanathan Seshadri
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
| | - Katie Gu
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
| | - Xiang Da Dong
- Division of Surgical Oncology, Nuvance Health, Norwalk, CT 06856, United States
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13
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Yang C, Ren X, Cui Y, Jiang H, Yu K, Li M, Zhao X, Zhu Q, Lin S. Nomograms for predicting cancer-specific survival in patients with primary central nervous system lymphoma: a population-based analysis. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1055. [PMID: 34422967 PMCID: PMC8339814 DOI: 10.21037/atm-21-753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/13/2021] [Indexed: 11/06/2022]
Abstract
Background This study identified the risk factors for survival in patients with primary central nervous system lymphoma (PCNSL). Nomograms were developed and validated to predict individualized overall survival (OS) and cancer-specific survival (CSS) in this particular cohort. Methods Patients diagnosed with PCNSL between 1975 and 2016 were selected from the Surveillance, Epidemiology, and End Results (SEER) database for this study. The Cox regression model, the Fine and Grey's model, and the backward method were applied to determine the risk factors for OS and CSS. Nomograms were established accordingly. Internal and external validation was performed in an Asian population to examine the accuracy of the nomograms. Results A total of 5,900 patients with PCNSL were identified from the SEER database. A further 163 patients with PCNSL from the Beijing Tiantan Hospital between 2004 and 2018 were included. Age at diagnosis, tumor site, pathological subtype, surgery, chemotherapy, coexisting malignancies, and HIV infection were independent risk factors of CSS. In addition to the risk factors of CSS, gender, marital status, and radiation were also independent factors of OS. Nomograms were developed to estimate the 1-, 3-, and 5-year OS and CSS. The discrimination and calibration of the nomograms performed well. The C-indexes of the nomograms for OS and CSS prediction were 0.728 [95% confidence interval (CI): 0.703-0.753] and 0.726 (95% CI: 0.696-0.756), respectively. In addition, compared with previously published OS nomograms, the newly established nomograms displayed superior prediction for OS. Conclusions Nomograms predicting the 1-, 3- and 5-year OS and CSS of patients with PCNSL were established in this study. The validated nomograms showed relatively good performance and may be used clinically to evaluate patients' individualized risk and prognosis with PCNSL. Free software for individualized survival prediction is provided at http://www.pcnsl-survivalprediction.cn.
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Affiliation(s)
- Chuanwei Yang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Xiaohui Ren
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Yong Cui
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Haihui Jiang
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Kefu Yu
- Department of Pharmacy, Beijing Tiantan Hospital of Capital Medical University, Beijing, China
| | - Mingxiao Li
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Xuzhe Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Qinghui Zhu
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
| | - Song Lin
- Department of Neurosurgery, Beijing Tiantan Hospital of Capital Medical University, Beijing Neurosurgical Institute, China National Clinical Research Center for Neurological Diseases, Center of Brain Tumor, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Brain Tumor, Beijing, China
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14
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Li L, Ren T, Liu K, Li ML, Geng YJ, Yang Y, Li HF, Li XC, Bao RF, Shu YJ, Weng H, Gong W, Lau WY, Wu XS, Liu YB. Development and Validation of a Prognostic Nomogram Based on the Systemic Immune-Inflammation Index for Resectable Gallbladder Cancer to Predict Survival and Chemotherapy Benefit. Front Oncol 2021; 11:692647. [PMID: 34268122 PMCID: PMC8276054 DOI: 10.3389/fonc.2021.692647] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/07/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives To investigate the prognostic significance of the systemic immune-inflammation index (SII) in patients after radical cholecystectomy for gallbladder cancer (GBC) using overall survival (OS) as the primary outcome measure. Methods Based on data from a multi-institutional registry of patients with GBC, significant prognostic factors after radical cholecystectomy were identified by multivariate Cox proportional hazards model. A novel staging system was established, visualized as a nomogram. The response to adjuvant chemotherapy was compared between patients in different subgroups according to the novel staging system. Results Of the 1072 GBC patients enrolled, 691 was randomly selected in the discovery cohort and 381 in the validation cohort. SII>510 was found to be an independent predictor of OS (hazard ratio [HR] 1.90, 95% confidence interval [CI] 1.42-2.54). Carbohydrate antigen 199(CA19-9), tumor differentiation, T stage, N stage, margin status and SII were involved in the nomogram. The nomogram showed a superior prediction compared with models without SII (1-, 3-, 5-year integrated discrimination improvement (IDI):2.4%, 4.1%, 5.4%, P<0.001), and compared to TNM staging system (1-, 3-, 5-year integrated discrimination improvement (IDI):5.9%, 10.4%, 12.2%, P<0.001). The C-index of the nomogram in predicting OS was 0.735 (95% CI 0.683-0.766). The novel staging system based on the nomogram showed good discriminative ability for patients with T2 or T3 staging and with negative lymph nodes after R0 resection. Adjuvant chemotherapy offered significant survival benefits to these patients with poor prognosis. Conclusions SII was an independent predictor of OS in patients after radical cholecystectomy for GBC. The new staging system identified subgroups of patients with T2 or T3 GBC with negative lymph nodes who benefited from adjuvant chemotherapy. Clinical Trial Registration ClinicalTrials.gov, identifier (NCT04140552).
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Affiliation(s)
- Lin Li
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tai Ren
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China
| | - Ke Liu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mao-Lan Li
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya-Jun Geng
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Yang
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huai-Feng Li
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xue-Chuan Li
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Run-Fa Bao
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yi-Jun Shu
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hao Weng
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Gong
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, Hong Kong
| | - Xiang-Song Wu
- Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Department of General Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Bin Liu
- Department of Biliary-Pancreatic Surgery, Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Research Center of Biliary Tract Disease, Renji Hospital, Shanghai, China.,Shanghai Cancer Institute, State Key Laboratory of Oncogenes and Related Genes, Shanghai, China
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15
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Sun L, Ke X, Wang D, Yin H, Jin B, Xu H, Du S, Xu Y, Zhao H, Lu X, Sang X, Zhong S, Yang H, Mao Y. Prognostic Value of the Albumin-to-γ-glutamyltransferase Ratio for Gallbladder Cancer Patients and Establishing a Nomogram for Overall Survival. J Cancer 2021; 12:4172-4182. [PMID: 34093818 PMCID: PMC8176430 DOI: 10.7150/jca.49242] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 04/23/2021] [Indexed: 01/05/2023] Open
Abstract
Purpose: The albumin-to-γ-glutamyltransferase ratio (AGR), a novel inflammation-related index, has been reported to have prognostic importance in several malignancies but not yet in gallbladder cancer (GBC). This study intended to assess the prognostic value of AGR in GBC and to develop a nomogram based on AGR for predicting overall survival (OS) in GBC patients after surgery. Methods: Medical records of 140 qualified GBC patients between July 2003 and June 2017 were retrospectively analyzed. The function “surv_cutpoint” in the R package “survminer” was implemented to discover the optimal cut-off value of AGR. A nomogram on the fundamental of Cox model was established in the training cohort and was internally validated using calibration curves, Harrell's concordance index, time-dependent AUC plots and decisive curve analyses. Results: The optimal AGR cut-off value concerning overall survival was 2.050. Univariate and multivariate analyses demonstrated that AGR (HR=0.354, P=0.004), T stage (HR=3.114, P=0.004), R0 resection (HR=0.448, P=0.003), BMI (HR=0.470, P=0.002) and CA19-9 (HR=1.704, P=0.048) were independent predictors for OS. The nomogram combining these prognostic factors showed considerable prognostic performance in term of consistency, discrimination and net benefit. Conclusion: AGR has independent prognostic value for OS in GBC patients receiving surgery. A nomogram incorporating AGR, T stage, R0 resection, CA19-9 and BMI achieved enhanced prognostic ability.
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Affiliation(s)
- Lejia Sun
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xindi Ke
- Peking Union Medical College (PUMC), PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Dongyue Wang
- Peking Union Medical College (PUMC), PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Huanhuan Yin
- Peking Union Medical College (PUMC), PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Bao Jin
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Haifeng Xu
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Shunda Du
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yiyao Xu
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Haitao Zhao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xin Lu
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Xinting Sang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Shouxian Zhong
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Huayu Yang
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Yilei Mao
- Department of Liver Surgery, Peking Union Medical College (PUMC) Hospital, PUMC & Chinese Academy of Medical Sciences, Beijing, 100730, China
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16
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Lin Y, Chen H, Pan F. Prognostic Nomograms to Predict Survival of Patients with Resectable Gallbladder Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Based Analysis. Med Sci Monit 2021; 27:e929106. [PMID: 33784268 PMCID: PMC8019267 DOI: 10.12659/msm.929106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Gallbladder adenocarcinoma (GBAC) is globally acknowledged as one of the most common malignancies among all gastrointestinal cancers. Despite prognosis of GBAC patients remains poor, patients with early-stage disease can be observed with long-term survival. Material/Methods In this study, 2556 patients with pathological GBAC between 2010 and 2015 were derived from the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic nomograms containing all independent prognostic factors for predicting overall survival (OS) and cancer-specific survival (CSS) were constructed to achieve superior prognostic discriminatory ability. Results Based on the AJCC 7th TNM staging system, we found the TNM substaging was not accurate enough to predict the survival and stratify the risk. Based on the results of univariate and multivariate analyses, a more precise prognostic nomogram was constructed containing all significant independent prognostic factors (age, grade, TNM stage, bone metastasis, and chemotherapy) for OS, while age, grade, TNM stage, bone metastasis and radiotherapy significant independent prognostic factors for CSS. The C-index of the constructed nomogram for predicting OS and CSS was 0.740 and 0.737 higher than that of TNM staging alone (0.667 for OS and 0.689 for CSS), respectively. In addition, the calibration curves and decision curve analysis further showed its robust power in survival prediction. Conclusions The constructed nomograms showed better discrimination abilities to predict OS and CSS rates at 1, 3, and 5 years. In the future, these constructed models for this disease will assist in risk stratification to guide GBAC treatment.
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Affiliation(s)
- Yan Lin
- Department of Gastroenterology, Fuzhou Second Hospital Affiliated to Xiamen University, Fuzhou, Fujian, China (mainland)
| | - Hua Chen
- Department of General Surgery, Ningde Medical District, 900th Hospital of the Joint Logistics Team, People's Liberation Army (PLA), Ningde, Fujian, China (mainland)
| | - Fan Pan
- Department of Hepatobiliary Surgery, 900th Hospital of the Joint Logistics Team, People's Liberation Army (PLA), Fuzhou, Fujian, China (mainland)
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Zhang Y, Zhou T, Han S, Chang J, Jiang W, Wang Z, Li C, Li X. 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. Int J Clin Oncol 2021; 26:1120-1129. [PMID: 33666788 DOI: 10.1007/s10147-021-01891-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 02/20/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS Patients with GBC were classified into 1-13 mm, 14-63 mm and 64 mm 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. CONCLUSIONS 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.
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Affiliation(s)
- Yaodong Zhang
- Key Laboratory on Living Donor Transplantation, Ministry of Health, Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Tao Zhou
- Key Laboratory on Living Donor Transplantation, Ministry of Health, Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Sheng Han
- Key Laboratory on Living Donor Transplantation, Ministry of Health, Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Jiang Chang
- Key Laboratory on Living Donor Transplantation, Ministry of Health, Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wangjie Jiang
- Key Laboratory on Living Donor Transplantation, Ministry of Health, Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Ziyi Wang
- Key Laboratory on Living Donor Transplantation, Ministry of Health, Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Changxian Li
- Key Laboratory on Living Donor Transplantation, Ministry of Health, Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Xiangcheng Li
- Key Laboratory on Living Donor Transplantation, Ministry of Health, Hepatobiliary/Liver Transplantation Center, The First Affiliated Hospital of Nanjing Medical University, 300# Guangzhou Road, Nanjing, 210029, Jiangsu, China.
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Leigh N, Pletcher E, Solomon D, Sarpel U, Labow DM, Magge DR, Golas BJ. The significance of anatomic tumor location in gallbladder cancer. J Surg Oncol 2020; 123:932-938. [PMID: 33368336 DOI: 10.1002/jso.26345] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Current management guidelines recognize the impact of hepatic versus peritoneal sided gallbladder cancers (GBC) on survival. However, no data exist regarding the significance of anatomic tumor location within the gallbladder. METHODS We retrospectively analyzed all GBC that underwent surgical resection with curative intent in our health system from 2007 to 2017. We evaluated the effect of anatomic pathologic tumor location (fundus/body, neck, and multifocal) on clinicopathologic, perioperative, and oncologic outcomes. RESULTS About 97 patients met criteria; 63% fundus/body, 22% multifocal, and 15% neck. Compared with fundus/body, neck tumors more frequently presented with preoperative jaundice (53% vs. 13%, p < .001), were smaller (20 mm vs. 30 mm, p = .068) and had significantly more biliary tree invasion (33% vs. 13%, p = .030) on histopathology. Although tumor characteristics (pTNM stage, liver invasion, lymphovascular invasion, prognostic nutritional index, and grade) were similar, neck tumors had significantly higher rates of R0 resection (53% vs. 11%, p < .001). Rates of adjuvant therapy were similar. Median PFS was similar between cohorts (p = .356). However, median overall survival (OS) was significantly shorter in neck (21 months) than fundus/body tumors (NR > 109 months), p = .015. CONCLUSIONS Neck tumors were rare, small and more likely to result in jaundice secondary to biliary tree invasion. Despite higher R0 resection rates, these tumors had significantly worse OS.
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Affiliation(s)
- Natasha Leigh
- Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai Morningside and West Hospital, New York, New York, USA
| | - Eric Pletcher
- Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai Morningside and West Hospital, New York, New York, USA
| | - Daniel Solomon
- Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai Morningside and West Hospital, New York, New York, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai Morningside and West Hospital, New York, New York, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai Morningside and West Hospital, New York, New York, USA
| | - Deepa R Magge
- Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai Morningside and West Hospital, New York, New York, USA
| | - Benjamin J Golas
- Division of Surgical Oncology, Icahn School of Medicine at Mount Sinai Morningside and West Hospital, New York, New York, USA
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García P, Lamarca A, Díaz J, Carrera E, Roa JC. Current and New Biomarkers for Early Detection, Prognostic Stratification, and Management of Gallbladder Cancer Patients. Cancers (Basel) 2020; 12:E3670. [PMID: 33297469 PMCID: PMC7762341 DOI: 10.3390/cancers12123670] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/06/2020] [Accepted: 11/11/2020] [Indexed: 01/17/2023] Open
Abstract
Gallbladder cancer (GBC) is an aggressive disease that shows evident geographic variation and is characterized by a poor prognosis, mainly due to the late diagnosis and ineffective treatment. Genetic variants associated with GBC susceptibility, including polymorphisms within the toll-like receptors TLR2 and TLR4, the cytochrome P450 1A1 (CYP1A1), and the ATP-binding cassette (ABC) transporter ABCG8 genes, represent promising biomarkers for the stratification of patients at higher risk of GBC; thus, showing potential to prioritize cholecystectomy, particularly considering that early diagnosis is difficult due to the absence of specific signs and symptoms. Similarly, our better understanding of the gallbladder carcinogenic processes has led to identify several cellular and molecular events that may influence patient management, including HER2 aberrations, high tumor mutational burden, microsatellite instability, among others. Despite these reports on interesting and promising markers for risk assessment, diagnosis, and prognosis; there is an unmet need for reliable and validated biomarkers that can improve the management of GBC patients and support clinical decision-making. This review article examines the most potentially significant biomarkers of susceptibility, diagnosis, prognosis, and therapy selection for GBC patients, highlighting the need to find and validate existing and new molecular biomarkers to improve patient outcomes.
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Affiliation(s)
- Patricia García
- Department of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile;
| | - Angela Lamarca
- Department of Medical Oncology, The Christie NHS Foundation Trust, Division of Cancer Sciences, University of Manchester, Manchester M20 4BX, UK;
| | - Javier Díaz
- Departamento del Aparato Digestivo, Hospital Nacional Edgardo Rebagliati Martins-Essalud, School of Medicine, Universidad Nacional Mayor de San Marcos, Lima 15081, Peru;
| | - Enrique Carrera
- Department of Gastroenterology, Hospital Especialidades Eugenio Espejo, Universidad San Francisco de Quito, Quito 170136, Ecuador;
| | - Juan Carlos Roa
- Department of Pathology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile;
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CT-based nomogram for predicting survival after R0 resection in patients with gallbladder cancer: a retrospective multicenter analysis. Eur Radiol 2020; 31:3336-3346. [PMID: 33185751 DOI: 10.1007/s00330-020-07402-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 08/14/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To establish a prognostic nomogram for patients undergoing R0 resection for gallbladder cancer based on preoperative CT. METHODS A total of 151 patients (64 males, 87 females; mean age, 73.26 years) with gallbladder cancer who underwent CT and surgery with margin-negative resection were retrospectively collected at two tertiary institutions. The demographic and radiologic parameters were analyzed using univariate and multivariate Cox regression analyses to identify independent prognostic factors. The final CT-based nomogram was constructed to predict prognosis after curative resection of gallbladder cancer. Calibration curves for the survival probabilities were obtained for internal validation. RESULTS Mass-forming type (hazard ratio [HR], 28.80), bile duct invasion (HR, 4.76), duodenal invasion (HR, 6.32), colon invasion (HR, 4.37), gallstones (HR, 0.09), and cholecystitis (HR, 2.56) were significant independent predictors for recurrence-free survival (p < .05). Mass-forming type (HR, 8.16, p < .001), bile duct invasion (HR, 2.92, p = .013), duodenal invasion (HR, 3.72, p = .012), and regional lymph node metastasis (HR, 2.07, p = .043) were independent predictors of poor cancer-specific survival (CSS) and were used to construct the nomogram. The nomogram showed a good predictive ability for the probabilities of survival on the calibration curves, and the concordance index of the model in predicting CSS was .768. CONCLUSION Preoperative CT findings could predict the prognosis of gallbladder cancer, and the CT-based nomogram accurately predicted CSS in patients with gallbladder cancer after attempted curative resection. KEY POINTS • Among the preoperative imaging features, mass-forming type, bile duct invasion, duodenal invasion, and regional lymph node metastasis were independent predictors of poor cancer-specific survival. • The nomogram constructed using preoperative CT findings showed a good predictive ability for the survival on calibration curves, and the concordance index of the model in predicting cancer-specific survival was 0.768.
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Bennett S, Søreide K, Gholami S, Pessaux P, Teh C, Segelov E, Kennecke H, Prenen H, Myrehaug S, Callegaro D, Hallet J. Strategies for the delay of surgery in the management of resectable hepatobiliary malignancies during the COVID-19 pandemic. Curr Oncol 2020; 27:e501-e511. [PMID: 33173390 PMCID: PMC7606047 DOI: 10.3747/co.27.6785] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objective We aimed to review data about delaying strategies for the management of hepatobiliary cancers requiring surgery during the covid-19 pandemic. Background Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible. Methods An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma. Results Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed. Conclusions There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.
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Affiliation(s)
- S Bennett
- Canada: Department of Surgery, University of Toronto, Toronto, ON (Bennett, Callegaro, Hallet); Department of Radiation Oncology, University of Toronto, Toronto, ON (Myrehaug); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Hallet)
| | - K Søreide
- Norway: Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, and Department of Clinical Medicine, University of Bergen, Bergen
| | - S Gholami
- United States: Division of Surgical Oncology, Department of Surgery, University of California, Davis, CA (Gholami); Virginia Mason Cancer Institute, Seattle, WA (Kennecke)
| | - P Pessaux
- France: Department of Surgery, Institut Hospitalo-Universitaire de Strasbourg, Strasbourg
| | - C Teh
- Philippines: Institute of Surgery, St. Luke's Medical Center, Quezon City; Department of Surgery, Makati Medical Center, Makati; and Department of General Surgery, National Kidney and Transplant Institute, Quezon City
| | - E Segelov
- Australia: Monash University and Monash Health, Melbourne
| | - H Kennecke
- United States: Division of Surgical Oncology, Department of Surgery, University of California, Davis, CA (Gholami); Virginia Mason Cancer Institute, Seattle, WA (Kennecke)
| | - H Prenen
- Belgium: Department of Oncology, University Hospital Antwerp, Antwerp
| | - S Myrehaug
- Canada: Department of Surgery, University of Toronto, Toronto, ON (Bennett, Callegaro, Hallet); Department of Radiation Oncology, University of Toronto, Toronto, ON (Myrehaug); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Hallet)
| | - D Callegaro
- Canada: Department of Surgery, University of Toronto, Toronto, ON (Bennett, Callegaro, Hallet); Department of Radiation Oncology, University of Toronto, Toronto, ON (Myrehaug); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Hallet)
- Italy: Department of Surgery, Fondazione irccs Istituto Nazionale Tumori, Milan
| | - J Hallet
- Canada: Department of Surgery, University of Toronto, Toronto, ON (Bennett, Callegaro, Hallet); Department of Radiation Oncology, University of Toronto, Toronto, ON (Myrehaug); Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON (Hallet)
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Cai YL, Lin YX, Xiong XZ, Ye H, Li FY, Cheng NS. Postsurgical radiotherapy in stage IIIB gallbladder cancer patients with one to three lymph nodes metastases: A propensity score matching analysis. Am J Surg 2020; 221:642-648. [PMID: 32859350 DOI: 10.1016/j.amjsurg.2020.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/30/2020] [Accepted: 08/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The effect of postsurgical radiotherapy (PSRT) among T1-3 gallbladder cancer (GBC) patients with one to three lymph node metastases remains controversial. The aim of this study was to assess the impact of PSRT on gallbladder cancer-specific survival (GBCSS) in patients with stage IIIB. METHODS The data of GBC patients were obtained from the American Surveillance, Epidemiology, and End Results (SEER) Data resources between 2004 and 2015. Then, a 1:1 propensity score matching (PSM) method was performed. GBCSS was compared among all patients. Subgroup analysis was conducted to identify patients who would benefit from PSRT. RESULTS 726 AJCC (8th edition) stage IIIB GBC patients were included. PSRT failed to improve GBCSS (p = 0.168). Male sex, tumor size ≥ 4 cm and absence of chemotherapy were independent negative prognostic factors. No significant survival benefit from PSRT was found in any subgroup. CONCLUSIONS PSRT provides no survival benefit for IIIB GBC.
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Affiliation(s)
- Yu-Long Cai
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Yi-Xin Lin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Xian-Ze Xiong
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Hui Ye
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China
| | - Nan-Sheng Cheng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China.
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Wu Y, Li Q, Cai Z, Zhang Y, Qiu Y, Yang N, Song T, Li S, Lou J, Li J, Mao X, Chen C, Zhang D, Si S, Geng Z, Tang Z. Survival prediction for gallbladder carcinoma after curative resection: Comparison of nomogram and Bayesian network models. Eur J Surg Oncol 2020; 46:2106-2113. [PMID: 32807616 DOI: 10.1016/j.ejso.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/24/2020] [Accepted: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In this study, we developed a nomogram and a Bayesian network (BN) model for prediction of survival in gallbladder carcinoma (GBC) patients following surgery and compared the performance of the two models. METHODS Survival prediction models were established and validated using data from 698 patients with GBC who underwent curative-intent resection between 2008 and 2017 at one of six Chinese tertiary hospitals. Model construction and internal validation were performed using data from 381 patients at one hepatobiliary center, and external validation was then performed using data from 317 patients at the other five centers. A BN model and a nomogram model were constructed based on the independent prognostic variables. Performance of the BN and nomogram models was compared based on area under receiver operating characteristic curves (AUC), model accuracy, and a confusion matrix. RESULTS Independent prognostic variables included age, pathological grade, liver infiltration, T stage, N stage, and margin. In internal validation, AUC was 84.14% and 78.22% for the BN and nomogram, respectively, and model accuracy was 75.65% and 72.17%, respectively. In external validation, AUC was 76.46% and 70.19% for the BN and nomogram, respectively, with model accuracy of 66.88% and 60.25%, respectively. Based on the confusion matrix, the nomogram had a higher true positive rate but a substantially lower true negative rate compared to the BN. CONCLUSION A BN model was more accurate than a Cox regression-based nomogram for prediction of survival in GBC patients undergoing curative-intent resection.
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Affiliation(s)
- Yuhan Wu
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi, China
| | - Qi Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Zhiqiang Cai
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi, China
| | - Yongjie Zhang
- Department of Biliary Surgery, Eastern Hepatobiliary Hospital Affiliated to Naval Medical University, Shanghai, 200433, China
| | - Yinghe Qiu
- Department of Biliary Surgery, Eastern Hepatobiliary Hospital Affiliated to Naval Medical University, Shanghai, 200433, China
| | - Ning Yang
- Department of Biliary Surgery, Eastern Hepatobiliary Hospital Affiliated to Naval Medical University, Shanghai, 200433, China
| | - Tianqiang Song
- Department of Hepatobiliary Oncology, Tianjin Medical University Cancer Hospital, Tianjin, 300060, China
| | - Shengping Li
- Department of Hepatobiliary Oncology, Sun Yat-sen University Cancer Center, Guangzhou, 510060, Guangdong, China
| | - Jianying Lou
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Jiangtao Li
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, 310009, Zhejiang, China
| | - Xianhai Mao
- Department of Hepatobiliary Surgery, Hunan Provincial People's Hospital, Changsha, 410005, Hunan, China
| | - Chen Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Dong Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China
| | - Shubin Si
- Department of Industrial Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an, 710072, Shaanxi, China
| | - Zhimin Geng
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, Shaanxi, China.
| | - Zhaohui Tang
- Department of General Surgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 200092, China.
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Han D, Yang J, Xu F, Huang Q, Bai L, Wei YL, Kaaya RE, Wang S, Lyu J. Prognostic factors in patients with gallbladder adenocarcinoma identified using competing-risks analysis: A study of cases in the SEER database. Medicine (Baltimore) 2020; 99:e21322. [PMID: 32756116 PMCID: PMC7402769 DOI: 10.1097/md.0000000000021322] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
A competing-risks model was developed in this study to identify the significant prognostic factors and evaluate the cumulative incidence of cause-specific death in gallbladder adenocarcinoma (GBAC), with the aim of providing guidance on effective clinical treatments.All patients with GBAC in the Surveillance, Epidemiology, and End Results (SEER) database during 1973 to 2015 were identified. The potential prognostic factors were identified using competing-risks analyses implemented using the R and SAS statistical software packages. We calculated the cumulative incidence function (CIF) for cause-specific death and death from other causes at each time point. The Fine-Gray proportional-subdistribution-hazards model was then applied in univariate and multivariate analyses to test the differences in CIF between different groups and identify independent prognostic factors.This study included 3836 eligible patients who had been enrolled from 2004 to 2015 in the SEER database. The univariate analysis indicated that age, race, AJCC stage, RS, tumor size, SEER historic stage, grade, surgery, radiotherapy, chemotherapy and adjuvant therapy (RCT, SRT, SCT and SRCT) were significant factors affecting the probability of death due to GBAC. The multivariate analysis indicated that age, race, AJCC stage, RS status, tumor size, grade and SRT were independent prognostic factors affecting GBAC cancer-specific death. A nomogram model was constructed based on multivariate models for death related to GBAC.We have constructed the first competing-risks nomogram for GBAC. The model was found to perform well. This novel validated prognostic model may facilitate the choosing of beneficial treatment strategies and help when predicting survival.
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Affiliation(s)
- Didi Han
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi
| | - Jin Yang
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi
| | - Fengshuo Xu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan
| | - Ling Bai
- Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Yuan-long Wei
- Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University
| | - Rahel Elishilia Kaaya
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi
| | - ShengPeng Wang
- Cardiovascular Research Center, School of Basic Medical Sciences, Xi’an Jiaotong University Health Science Center
- Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
| | - Jun Lyu
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province
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Prognostic Evaluation for Patients over 45 Years Old with Gallbladder Adenocarcinoma Resection: A SEER-Based Nomogram Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6370946. [PMID: 32733948 PMCID: PMC7383319 DOI: 10.1155/2020/6370946] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/16/2020] [Accepted: 06/29/2020] [Indexed: 12/14/2022]
Abstract
Gallbladder adenocarcinoma is the main histopathological type of gallbladder cancer (GBC), so it is particularly important to understand its biological characteristics. Due to the low incidence of this type of cancer, there are few studies with large sample sizes. The log of positive lymph nodes (LODDS) has been evaluated by many scholars as a lymph node stage that may play a better role than the 8th edition of the American Joint Committee on Cancer (AJCC) lymph node staging system in many cancers. However, the effect of LODDS has not been proven in gallbladder adenocarcinoma. Our research aimed to identify independent prognostic factors that are closely related to overall survival (OS) in patients with gallbladder adenocarcinoma over 45 years of age using data from the Surveillance, Epidemiology and, End Results (SEER) database. All patients were randomly divided into a modeling cohort and an internal validation cohort. Seven independent prognostic factors associated with OS—age, marital status, grade, tumor size, AJCC 8th edition T stage and M stage, and LODDS—were used to build a nomogram to predict 1-, 3-, and 5-year survival. The C-index of our nomogram was 0.735 (95% CI, 0.716 to 0.754), and together with the calibration curve and ROC curve validation, the results confirmed the prediction effect of our nomogram. We believe that our nomogram will be an accurate and convenient method for patient prognosis assessment in the future.
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Shi Z, Xiao Z, Li L, Hu L, Gao Y, Zhao J, Liu Y, Huang D, Xu Q. Application of nomogram containing log odds of metastatic lymph node in gallbladder cancer patients. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:655. [PMID: 32566592 PMCID: PMC7290604 DOI: 10.21037/atm-2020-91] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Zhan Shi
- Graduate Department, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310014, China.,Department of Hepatic-biliary-pancreatic Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Zunqiang Xiao
- Graduate Department, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou 310014, China.,Department of Hepatic-biliary-pancreatic Surgery, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Lijie Li
- Department of Obstetrics and Gynecology, Zhejiang Hospital, Hangzhou 310012, China
| | - Linjun Hu
- Graduate Department, The Medical College of Qingdao University, Qingdao 266071, China
| | - Yuling Gao
- Department of Genetic Laboratory, Shaoxing Women and Children Hospital, Shaoxing 312030, China
| | - Junjun Zhao
- Graduate Department, Bengbu Medical College, Bengbu 233030, China
| | - Yang Liu
- Graduate Department, The Medical College of Qingdao University, Qingdao 266071, China
| | - Dongsheng Huang
- The Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
| | - Qiuran Xu
- The Key Laboratory of Tumor Molecular Diagnosis and Individualized Medicine of Zhejiang Province, Zhejiang Provincial People's Hospital (People's Hospital of Hangzhou Medical College), Hangzhou 310014, China
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Cai YL, Lin YX, Jiang LS, Ye H, Li FY, Cheng NS. A Novel Nomogram Predicting Distant Metastasis in T1 and T2 Gallbladder Cancer: A SEER-based Study. Int J Med Sci 2020; 17:1704-1712. [PMID: 32714073 PMCID: PMC7378661 DOI: 10.7150/ijms.47073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/19/2020] [Indexed: 02/05/2023] Open
Abstract
Background: Gallbladder cancer (GBC) is the most common malignancy of the biliary system. Early T stage GBC patients with distant metastasis are proven to have a worse prognosis. In this study, our aim was to construct and validate a novel nomogram for predicting distant metastasis in T1 and T2 GBC. Methods: Between 2004 and 2014, patients with T1 and T2 GBC were identified in the Surveillance, Epidemiology, and End Results (SEER) database. All of the eligible patients were randomly divided into training and validation cohorts. Univariate and multivariate analyses were used to assess significant predictive factors associated with distant metastasis. A nomogram was developed and validated by a calibration curve and receptor operating characteristic curve (ROC) analysis. Results: According to the inclusion and exclusion criteria, 3013 patients with historically confirmed AJCC stage T1 and T2 GBC were enrolled. Younger age, high pathological grade, nonadenocarcinoma, T1, N1 and larger tumor size correlated positively with the risk of distant metastasis. A novel nomogram was established to predict distant metastasis in early T stage GBC patients. Internal validation with a calibration plot in the training cohort showed that this nomogram was well calibrated. Through ROC curve analysis, the areas under the ROC curves in the training and validation cohorts were 0.723 and 0.679, respectively. Conclusions: Although some limitations exist in this predictive model, the nomogram revealed the relationship between the clinicopathological characteristics of T1 and T2 GBC patients and the risk of distant metastasis. The novel nomogram will assist in patient counseling and guide treatment decision making for T1 and T2 GBC patients.
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Affiliation(s)
- Yu-Long Cai
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yi-Xin Lin
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li-Sheng Jiang
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Hui Ye
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Nan-Sheng Cheng
- Department of Biliary Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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He C, Cai Z, Zhang Y, Lin X. Prognostic Model to Predict Cancer-Specific Survival for Patients With Gallbladder Carcinoma After Surgery: A Population-Based Analysis. Front Oncol 2019; 9:1329. [PMID: 31921622 PMCID: PMC6920125 DOI: 10.3389/fonc.2019.01329] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/14/2019] [Indexed: 12/25/2022] Open
Abstract
Predicting the prognosis of gallbladder carcinoma (GBC) has always been important for improving survival. The objective of this study was to determine the risk factors of survival for patients with GBC after surgery and to develop predictive nomograms for overall survival (OS) and cancer-specific survival (CSS) using a large population-based cohort. We identified 2,762 patients with primary resectable GBC in the Surveillance, Epidemiology, and End Results (SEER) database for the period of 2004 to 2014 and another 152 patients with GBC after surgery from Sun Yat-sen University Cancer Center (SYSUCC) for the period of 1997 to 2017. The 1-, 2-, and 3-year cancer-specific mortalities were 37.2, 52.9, and 59.9%, while the competing mortalities were 5.8, 7.8, and 9.0%, respectively. Nomograms were developed to estimate OS and CSS, and these were validated by concordance indexes (C-indexes) and evaluated using receiver operating characteristic (ROC) curves. The C-indexes of the nomograms for OS and CSS prediction were 0.704 and 0.732, respectively. In addition, compared with the 8th Tumor-Node-Metastasis staging system, the newly established nomograms displayed higher areas under the ROC curves for OS and PFS prediction. The nomograms are well-validated and could thus aid individual clinical practice.
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Affiliation(s)
- Chaobin He
- State Key Laboratory of Oncology in South China, Department of Hepatobiliary and Pancreatic Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Zhiyuan Cai
- State Key Laboratory of Oncology in South China, Department of Hepatobiliary and Pancreatic Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yu Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaojun Lin
- State Key Laboratory of Oncology in South China, Department of Hepatobiliary and Pancreatic Surgery, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
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Chen M, Lin J, Cao J, Zhu H, Zhang B, Wu A, Cai X. Development and validation of a nomogram for survival benefit of lymphadenectomy in resected gallbladder cancer. Hepatobiliary Surg Nutr 2019; 8:480-489. [PMID: 31673537 DOI: 10.21037/hbsn.2019.03.02] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Due to absence of large, prospective, randomized, clinical trial data, the potential survival benefit of lymphadenectomy with different number of regional lymph nodes (LNs) remains controversial. We aim to create a predicting model to help estimate individualized potential survival benefit of lymphadenectomy with more regional LNs for patients with resected gallbladder cancer (GBC). Methods Patients with resected GBC were selected from the Surveillance, Epidemiology, and End Results database who were diagnosed between 2004 and 2014. Covariates included age, race, sex, grade, histological stage, tumor sizes and receipt of non-primary surgery. Two types of multivariate survival regression models were constructed and compared. The best model performance was tested by the external validation data from our hospital. Results A total of 1,669 patients met the inclusion criteria for this study. The lognormal survival model showed the best performance and was tested by the external validation data, including 193 patients with resected GBC from our hospital. Nomograms, which based on the accelerated failure time parametric survival model, were built to estimate individualized survival. C-index, was up to 0.754 and 0.710 in internal validation for more and less regional LNs removed, respectively. Both of internal and external calibration curves showed good agreement between predicted and observed outcomes in the 1-, 3-, and 5-year overall survival (OS). Conclusions A predicting model can be used as a decision model to predict which patients may obtain benefit from lymphadenectomy with more regional LNs.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.,Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Jian Lin
- Longyou People's Hospital, Quzhou 324400, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Hepan Zhu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Bin Zhang
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
| | - Angela Wu
- Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China.,Key Laboratory of Endoscopic Technique Research of Zhejiang Province, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou 310016, China
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Yang J, Tian G, Pan Z, Zhao F, Feng X, Liu Q, Lyu J. Nomograms for predicting the survival rate for cervical cancer patients who undergo radiation therapy: a SEER analysis. Future Oncol 2019; 15:3033-3045. [PMID: 31452393 DOI: 10.2217/fon-2019-0029] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Aim: To integrate multiple independent risk factors to establish prognostic nomograms for better predicting overall survival and disease-specific survival in patients with cervical cancer receiving radiation therapy. Materials & methods: Cox analysis used to construct nomograms. The C-index, time-dependent receiver operating characteristic and calibration plots were used to evaluate the performance. The discrimination abilities were compared using the decision curve analysis, net reclassification improvement and integrated discrimination improvement. Results: After randomization, 2869 and 1230 cervical cancer patients were included in the training and validation sets, respectively. Nomograms that incorporated all of the significant independent factors for predicting the 3- and 5-year overall survival and disease-specific survival in the training cohort were established. Conclusion: Compared with the International Federation of Gynecology and Obstetrics staging system, the proposed nomograms exhibit superior prognostic discrimination and survival prediction.
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Affiliation(s)
- Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Guoxiang Tian
- Seventh Medical Center, PLA General Hospital, Beijing, 100853, PR China
| | - Zhenyu Pan
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China.,Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China
| | - Fanfan Zhao
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Xiaojie Feng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Qingqing Liu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, PR China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi, 710061, PR China
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Yang J, Pan Z, Zhou Q, Liu Q, Zhao F, Feng X, Lyu J. Nomogram for predicting the survival of patients with malignant melanoma: A population analysis. Oncol Lett 2019; 18:3591-3598. [PMID: 31516573 PMCID: PMC6732986 DOI: 10.3892/ol.2019.10720] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 07/10/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of the current study was to develop and validate a nomogram based on a large population to estimate the 3- and 5-year survival rates of patients with malignant melanoma (MM). Patients were selected from the Surveillance, Epidemiology and End Results database and randomly divided into the training and validation cohorts. A nomogram was developed, and was used to assess the accuracy of the model. Independent prognostic factors associated with overall survival (OS) rate were identified through multivariate analysis, and were included in the internal validation of the nomogram. The nomogram provided high C-indexes for the training cohort [area under the time-dependent receiver operating characteristic curve (AUC) of 0.877 for 3-year OS rate and 0.872 for 5-year OS rate] and the validation cohort (AUC of 0.880 for 3-year OS rate and 0.874 for 5-year OS rate), indicating that the model had good discrimination ability. Calibration plots showed that the predicted 3- and 5-year OS rates probabilities for the training and validation groups were almost identical to the actual observations. The 3- and 5-year decision curves indicated net benefits for both the training and validation cohorts. The nomogram may aid clinicians to provide more accurate prognosis prediction in patient consultations and more personalized postoperative management plans.
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Affiliation(s)
- Jin Yang
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Zhenyu Pan
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China.,Department of Pharmacy, The Affiliated Children Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China
| | - Quan Zhou
- Department of Science and Education, The First People's Hospital of Changde City, Changde, Hunan 415003, P.R. China
| | - Qingqing Liu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Fanfan Zhao
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Xiaojie Feng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China
| | - Jun Lyu
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi 710061, P.R. China.,School of Public Health, Xi'an Jiaotong University Health Science Center, Xi'an, Shaanxi 710061, P.R. China.,Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, Henan 475000, P.R. China
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Søreide K, Guest RV, Harrison EM, Kendall TJ, Garden OJ, Wigmore SJ. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg 2019; 106:32-45. [PMID: 30582640 DOI: 10.1002/bjs.11035] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. METHODS A systematic PubMed search of the English literature to May 2018 was conducted. RESULTS The search identified 12 systematic reviews and meta-analyses, in addition to several consensus reports, multi-institutional series and national audits. Some 0·25-0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one-third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5-year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross-sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port-site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. CONCLUSION Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.
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Affiliation(s)
- K Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R V Guest
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - T J Kendall
- Division of Pathology, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - O J Garden
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - S J Wigmore
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
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Bai Y, Liu ZS, Xiong JP, Xu WY, Lin JZ, Long JY, Miao F, Huang HC, Wan XS, Zhao HT. Nomogram to predict overall survival after gallbladder cancer resection in China. World J Gastroenterol 2018; 24:5167-5178. [PMID: 30568393 PMCID: PMC6288645 DOI: 10.3748/wjg.v24.i45.5167] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 10/23/2018] [Accepted: 11/09/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To integrate clinically significant variables related to prognosis after curative resection for gallbladder carcinoma (GBC) into a predictive nomogram.
METHODS One hundred and forty-two GBC patients who underwent curative intent surgical resection at Peking Union Medical College Hospital (PUMCH) were included. This retrospective case study was conducted at PUMCH of the Chinese Academy of Medical Sciences and Peking Union Medical College (CAMS & PUMC) in China from January 1, 2003 to January 1, 2018. The continuous variable carbohydrate antigen 19-9 (CA19-9) was converted into a categorical variable (cCA19-9) based on the normal reference range. Stages 0 to IIIA were merged into one category, while the remaining stages were grouped into another category. Pathological grade X (GX) was treated as a missing value. A multivariate Cox proportional hazards model was used to select variables to construct a nomogram. Discrimination and calibration of the nomogram were performed via the concordance index (C-index) and calibration plots. The performance of the nomogram was estimated using the calibration curve. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were performed to evaluate the predictive accuracy and net benefit of the nomogram, respectively.
RESULTS Of these 142 GBC patients, 55 (38.7%) were male, and the median and mean age were 64 and 63.9 years, respectively. Forty-eight (33.8%) patients in this cohort were censored in the survival analysis. The median survival time was 20 months. A series of methods, including the likelihood ratio test and Akaike information criterion (AIC) as well as stepwise, forward, and backward analyses, were used to select the model, and all yielded identical results. Jaundice [hazard ratio (HR) = 2.9; 95% confidence interval (CI): 1.60-5.27], cCA19-9 (HR = 3.2; 95%CI: 1.91-5.39), stage (HR = 1.89; 95%CI: 1.16-3.09), and resection (R) (HR = 2.82; 95%CI: 1.54-5.16) were selected as significant predictors and combined into a survival time predictive nomogram (C-index = 0.803; 95%CI: 0.766-0.839). High prediction accuracy (adjusted C-index = 0.797) was further verified via bootstrap validation. The calibration plot demonstrated good performance of the nomogram. ROC curve analysis revealed a high sensitivity and specificity. A high net benefit was proven by DCA.
CONCLUSION A nomogram has been constructed to predict the overall survival of GBC patients who underwent radical surgery from a clinical database of GBC at PUMCH.
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Affiliation(s)
- Yi Bai
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhi-Song Liu
- Department of Statistics, Tianjin University of Finance and Economics Pearl River College, Tianjin 301811, China
| | - Jian-Ping Xiong
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Wei-Yu Xu
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jian-Zhen Lin
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jun-Yu Long
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Fei Miao
- Department of Statistics, Tianjin University of Finance and Economics Pearl River College, Tianjin 301811, China
| | - Han-Chun Huang
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Xue-Shuai Wan
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Hai-Tao Zhao
- Department of Liver Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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