Survival analysis and prognostic factors of the carcinoma of gallbladder

Risk factors and survival prediction model establishment for prognosis in patients with radical resection of gallbladder cancer

BACKGROUND

Gallbladder cancer (GBC) is the most common malignant tumor of the biliary system, and is often undetected until advanced stages, making curative surgery unfeasible for many patients. Curative surgery remains the only option for long-term survival. Accurate postsurgical prognosis is crucial for effective treatment planning. tumor-node-metastasis staging, which focuses on tumor infiltration, lymph node metastasis, and distant metastasis, limits the accuracy of prognosis. Nomograms offer a more comprehensive and personalized approach by visually analyzing a broader range of prognostic factors, enhancing the precision of treatment planning for patients with GBC.

AIM

To identify risk factors and develop a predictive model for GBC prognosis.

METHODS

A retrospective study analyzed the clinical and pathological data of 93 patients who underwent radical surgery for GBC at Peking University People's Hospital from January 2015 to December 2020. Kaplan-Meier analysis was used to calculate the 1-, 2- and 3-year survival rates. The log-rank test was used to evaluate factors impacting prognosis, with survival curves plotted for significant variables. Single-factor analysis revealed statistically significant differences, and multivariate Cox regression identified independent prognostic factors. A nomogram was developed and validated with receiver operating characteristic curves and calibration curves.

RESULTS

Among 93 patients who underwent radical surgery for GBC, 30 patients survived, accounting for 32.26% of the sample, with a median survival time of 38 months. The 1-year, 2-year, and 3-year survival rates were 83.87%, 68.82%, and 53.57%, respectively. Univariate analysis revealed that carbohydrate antigen 19-9 expression, T stage, lymph node metastasis, histological differentiation, surgical margins, and invasion of the liver, extrahepatic bile duct, nerves, and vessels (P ≤ 0.001) significantly impacted patient prognosis after curative surgery. Multivariate Cox regression identified lymph node metastasis (P = 0.03), histological differentiation (P < 0.05), nerve invasion (P = 0.036), and extrahepatic bile duct invasion (P = 0.014) as independent risk factors. A nomogram model with a concordance index of 0.838 was developed. Internal validation confirmed the model's consistency in predicting the 1-year, 2-year, and 3-year survival rates.

CONCLUSION

Lymph node metastasis, tumor differentiation, extrahepatic bile duct invasion, and perineural invasion are independent risk factors. A nomogram based on these factors can be used to personalize and improve treatment strategies.

Prognostic Factors in Patients Diagnosed with Gallbladder Cancer over a Period of 20 Years: A Cohort Study

BACKGROUND

Gallbladder cancer (GBC) is an uncommon cancer. This study aimed to determine the outcomes of GBC in relation to geographic, demographic, and clinical factors in a Canadian province from 2000 to 2019.

METHODS

This population-based retrospective cohort study included all patients diagnosed with gallbladder cancer (GBC) in Saskatchewan, Canada, from 2000 to 2019. Cox proportional multivariate regression analysis was conducted to identify factors associated with poorer outcomes.

RESULTS

In total, 331 patients with a median age of 74 years and male-female ratio of 1:2 were identified. Of these patients, 305 (92%) had a pathological diagnosis of GBC. Among patients with documented staging data, 64% had stage IV disease. A total of 217 (66%) patients were rural residents, and 149 (45%) were referred to a cancer center. The multivariate analysis for patients with stage I-III GBC showed that stage III disease [hazard ratio (HR), 2.63; 95% confidence interval (CI), 1.09-6.34)] and urban residence (HR, 2.20; 95% CI, 1.1-4.39) were correlated with inferior disease-free survival. For all patients, stage IV disease (HR, 3.02; 95% CI, 1.85-4.94), no referral to a cancer center (HR, 2.64; 95% CI, 1.51-4.62), lack of surgery (HR, 1.63; 95% CI, 1.03-2.57), a neutrophil-lymphocyte ratio of >3.2 (HR, 1.57; 1.05-2.36), and age of ≥70 years (HR, 1.51; 95% CI, 1.04-2.19) were correlated with inferior overall survival.

CONCLUSIONS

In this real-world context, the majority of patients with GBC were diagnosed at a late stage and were not referred to a cancer center. For those with early-stage GBC, living in an urban area and having stage III disease were linked to worse outcomes. Across all stages of GBC, stage IV disease, older age, absence of surgery, lack of referral to a cancer center, and a high neutrophil-to-lymphocyte ratio were associated with poorer survival.

Is cross-species horizontal gene transfer responsible for gallbladder carcinogenesis

BACKGROUND

Cross-species horizontal gene transfer (HGT) involves the transfer of genetic material between different species of organisms. In recent years, mounting evidence has emerged that cross-species HGT does take place and may play a role in the development and progression of diseases.

METHODS

Transcriptomic data obtained from patients with gallbladder cancer (GBC) was assessed for the differential expression of antisense RNAs (asRNAs). The Basic Local Alignment Search Tool (BLAST) was used for cross-species analysis with viral, bacterial, fungal, and ancient human genomes to elucidate the evolutionary cross species origins of these differential asRNAs. Functional enrichment analysis and text mining were conducted and a network of asRNAs targeting mRNAs was constructed to understand the function of differential asRNAs better.

RESULTS

A total of 17 differentially expressed antisense RNAs (asRNAs) were identified in gallbladder cancer tissue compared to that of normal gallbladder. BLAST analysis of 15 of these asRNAs (AFAP1-AS1, HMGA2-AS1, MNX1-AS1, SLC2A1-AS1, BBOX1-AS1, ELFN1-AS1, TRPM2-AS, DNAH17-AS1, DCST1-AS1, VPS9D1-AS1, MIR1-1HG-AS1, HAND2-AS1, PGM5P4-AS1, PGM5P3-AS1, and MAGI2-AS) showed varying degree of similarities with bacterial and viral genomes, except for UNC5B-AS1 and SOX21-AS1, which were conserved during evolution. Two of these 15 asRNAs, (VPS9D1-AS1 and SLC2A1-AS1) exhibited a high degree of similarity with viral genomes (Chikungunya virus, Human immunodeficiency virus 1, Stealth virus 1, and Zika virus) and bacterial genomes including (Staphylococcus sp., Bradyrhizobium sp., Pasteurella multocida sp., and, Klebsiella pneumoniae sp.), indicating potential HGT during evolution.

CONCLUSION

The results provide novel evidence supporting the hypothesis that differentially expressed asRNAs in GBC exhibit varying sequence similarity with bacterial, viral, and ancient human genomes, indicating a potential shared evolutionary origin. These non-coding genes are enriched with methylation and were found to be associated with cancer-related pathways, including the P53 and PI3K-AKT signaling pathways, suggesting their possible involvement in tumor development.

Risk Factors and Prognostic Factors in GBC

Background: Gallbladder cancer (GBC) is a rare entity with a poor prognosis, usually discovered late due to nonspecific symptoms; therefore, over the last years, attention has been focused on identifying the risk factors for developing this malignancy in order to provide an early diagnosis, as well as new prognostic factors in order to modulate the long-term evolution of such cases. The aim of this review is to discuss both major risk factors and prognostic factors in GBC for a better understanding and integration of relevant and currently available information. Methods: A literature search was performed using Cochrane Library, PubMed, Google Scholar, Elsevier, and Web of Science; studies published after the year of 2000, in English, were reviewed. Results: Over time, risk factors associated with the development of GBC have been identified, which outline the profile of patients with this disease. The most important prognostic factors in GBC remain TNM staging, safety margin, and R0 status, along with perineural invasion and lymphovascular invasion. Both the technique and experience of the surgeons and a pathological examination that ensures final staging are particularly important and increase the chances of survival of the patients. Conclusions: improvements in surgical techniques and pathological analyses might provide better and more consistent guidance for medical staff in the management of patients with GBC.

Prognostic Insights and Survival Analysis of Gallbladder Cancer in Bihar, India: a Prospective Observational Study Emphasizing the Impact of Surgical Intervention on Overall Survival

The aim of this study was to determine the 1- and 3-year overall survival rates. This prospective observational study was conducted at a tertiary care center in Bihar state, India. The study analyzed 228 patients in Bihar with a median age at diagnosis of 55 ± 12.05 years. The most common symptoms included upper abdominal pain (26.3%), weight loss (14%), and ascites (13.6%). The majority of patients presented at stage IV (72.8%), with liver metastasis being prevalent (61.4%). Interventional biliary drainage was performed in 9.6% of cases, and systemic chemotherapy was received by 84.64%, while 15.36% opted for best supportive care. Univariate Cox regression analysis identified Eastern Cooperative Oncology Group (ECOG) performance status, stage, gallstone disease, and surgical intervention as significant risk factors influencing overall survival (OS) (p < 0.001). Multivariate Cox regression analysis confirmed ECOG performance status (p < 0.001), stage (p = 0.039), and surgical intervention (p = 0.038) as independent factors impacting OS. One-year OS rates for stages II, III, and IV were 100%, 97%, and 44%, respectively, while 3-year OS rates were 29%, 4%, and 0%. Surgical intervention significantly influenced OS (p < 0.001). OS for surgical intervention was 28 months, and for inoperable cases, it was 12 months. One- and 3-year OS for surgical intervention were 95% and 11%, while for inoperable cases, they were 41% and 0%, respectively. Patients with gallbladder cancer, particularly in Bihar's Gangetic plains, face poor survival, especially with advanced disease. Adequate surgery improves outcomes, prompting a call for enhanced strategies, particularly for locally advanced GBC.

Prognostic Significance of Tumor Necrosis in Patients with Gallbladder Carcinoma Undergoing Curative-Intent Resection

BACKGROUND

Tumor necrosis has been indicated to correlate with dismal survival outcomes of a variety of solid tumors. However, the significance and prognostic value of tumor necrosis remain unclear in gallbladder carcinoma. The aim of this research is to explore the relationships between necrosis with long-term survival and tumor-related biological characteristics of patients with gallbladder carcinoma.

PATIENTS AND METHODS

Patients with gallbladder carcinoma who accepted curative-intent resection in West China Hospital of Sichuan University (China) between January 2010 and December 2021 were retrospectively analyzed. Tumor necrosis was determined by staining the patient's original tissue sections with hematoxylin and eosin. Based on the presence of tumor necrosis, the pathologic features and survival outcomes were compared.

RESULTS

This study enrolled 213 patients with gallbladder carcinoma who underwent curative-intent surgery, of whom 89 had tumor necrosis. Comparative analyses indicated that patients with tumor necrosis had more aggressive clinicopathological features, such as larger tumor size (p = 0.002), poorer tumor differentiation (p = 0.029), more frequent vascular invasion (p < 0.001), presence of lymph node metastasis (p = 0.014), and higher tumor status (p = 0.01), and experienced poorer survival. Univariate and multivariate analyses revealed that tumor necrosis was an independent prognostic factor for overall survival (multivariate: HR 1.651, p = 0.026) and disease-free survival (multivariate: HR 1.589, p = 0.040).

CONCLUSIONS

Tumor necrosis can be considered as an independent predictive factor for overall survival and disease-free survival among individuals with gallbladder carcinoma, which was a valuable pathologic parameter.

WASF3 overexpression affects the expression of circular RNA hsa-circ-0100153, which promotes breast cancer progression by sponging hsa-miR-31, hsa-miR-767-3p, and hsa-miR-935

Background

The WASF3 gene has been linked to promoting metastasis in breast cancer (BC) cells, and low expression reduces invasion potential. Circular RNAs (circRNAs) function as microRNA (miRNA) modulators and are involved in cancer progression, but the relationship between these factors remains unclear.

Methods

This study used bioinformatics methods and a computational approach to investigate the role of circRNAs and miRNAs in the context of WASF3 overexpression. Differentially expressed mRNAs, circRNAs, and miRNAs were identified using Gene Expression Omnibus (GEO) datasets. A competing endogenous RNA (ceRNA) network was constructed based on circRNA-miRNA pairs and miRNA-mRNA pairs. Functional and pathway enrichment analyses were predicted using a circRNA-miRNA-mRNA network.

Results

RNA expression patterns were significantly different between normal and tumor samples. A total of 190 circRNAs, 76 miRNAs, and 678 mRNAs were differentially expressed. The analysis of the circRNA-miRNA-mRNA regulatory network revealed interactions between hsa-circ-0100153, hsa-miR-31, hsa-miR-767-3p, and hsa-miR-935 with WASF3 in cancer. These interactions primarily function in DNA replication and the cell cycle.

Conclusions

This study reveals a mechanism by which WASF3 overexpression affects the expression of circRNAs hsa-circ-0100153, promoting BC progression by sponging hsa-miR-31/hsa-miR-767-3p /hsa-miR-935. This mechanism may increase the invasive potential of cancers, in addition to other reported molecular mechanisms involving the WASF3 gene.

Effects of cytoreductive surgery combined with hyperthermic perfusion chemotherapy on prognosis of patients with advanced gallbladder cancer

BACKGROUND

Gallbladder cancer (GC) is a common malignant tumor and one of the leading causes of cancer-related death worldwide. It is typically highly invasive, difficult to detect in the early stages, and has poor treatment outcomes, resulting in high mortality rates. The available treatment options for GC are relatively limited. One emerging treatment modality is hyperthermic intraperitoneal chemotherapy (HIPEC). HIPEC involves delivering heated chemotherapy directly into the abdominal cavity. It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions, aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity.

AIM

To determine the effects of cytoreductive surgery (CRS) combined with HIPEC on the short-term prognosis of patients with advanced GC.

METHODS

Data from 80 patients treated at the Punan Branch of Renji Hospital, Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed. The control group comprised 44 patients treated with CRS, and the research group comprised 36 patients treated with CRS combined with HIPEC. Then, the survival time and prognostic factors of the two groups were compared, as well as liver and kidney function indices before and six days after surgery. Adverse reactions and complications were recorded in both groups.

RESULTS

The baseline data of the research and control groups were similar (P > 0.05). Six days after surgery, the alanine aminotransferase, aspartate aminotransferase, total bilirubin, and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups (P < 0.05). However, the values did not differ between the two groups six days postoperatively (P > 0.05). Similarly, the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups (P < 0.05), but they did not differ between the groups six days postoperatively (P > 0.05). Furthermore, the research group had fewer postoperative adverse reactions than the control group (P = 0.027). Finally, a multivariate Cox analysis identified the tumor stage, distant metastasis, and the treatment plan as independent factors affecting prognosis (P < 0.05). The three-year survival rate in the study group was higher than that in the control group (P = 0.002).

CONCLUSION

CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.