Biliary Neuroendocrine Neoplasms: Analysis of Prognostic Factors and Development and Validation of a Nomogram

Rachel score: a nomogram model for predicting the prognosis of lung neuroendocrine tumors

BACKGROUND

Lung NET, classified in typical carcinoids (TC) and atypical carcinoids (AC), are highly heterogeneous in their biology and prognosis. The histological subtype and TNM stage are well-established prognostic factors for lung NET. In a previous work by our group, we demonstrated a significant impact of laterality on lung NET survival outcomes.

MATERIALS AND METHODS

We developed a nomogram that integrates relevant prognostic factors to predict lung NET outcomes. By adding the scores for each of the variables included in the model, it was possible to obtain a prognostic score (Rachel score). Wilcoxon non-parametric statistical test was applied among parameters and Harrell's concordance index was used to measure the models' predictive power. To test the discriminatory power and the predictive accuracy of the model, we calculated Gonen and Heller concordance index. Time-dependent ROC curves and their area under the curve (AUC) were used to evaluate the models' predictive performance.

RESULTS

By applying Rachel score, we were able to identify three prognostic groups (specifically, high, medium and low risk). These three groups were associate to well-defined ranges of points according to the obtained nomogram (I: 0-90, II: 91-130; III: > 130 points), providing a useful tool for prognostic stratification. The overall survival (OS) and progression free survival (PFS) Kaplan-Meier curves confirmed significant differences (p < 0.0001) among the three groups identified by Rachel score.

CONCLUSIONS

A prognostic nomogram was developed, incorporating variables with significant impact on lung NET survival. The nomogram showed a satisfactory and stable ability to predict OS and PFS in this population, confirming the heterogeneity beyond the histopathological diagnosis of TC vs AC.

Clinical diagnosis and treatment of 37 cases of gallbladder neuroendocrine carcinoma

OBJECTIVE

This study aims to investigate the clinical and pathological characteristics, treatment approaches, and prognosis of gallbladder neuroendocrine carcinoma (GB-NEC).

METHODS

Retrospective analysis was conducted on the clinical data of 37 patients with GB-NEC admitted to Shanxi Cancer Hospital from January 2010 to June 2023. The study included an examination of their general information, treatment regimens, and overall prognosis.

RESULTS

Twelve cases, either due to distant metastasis or other reasons, did not undergo surgical treatment and received palliative chemotherapy (Group 1). Two cases underwent simple cholecystectomy (Group 2); four patients underwent palliative tumor resection surgery (Group 3), and nineteen patients underwent radical resection surgery (Group 4). Among the 37 GB-NEC patients, the average pre-surgery CA19-9 level was 113.29 ± 138.45 U/mL, and the median overall survival time was 19 months (range 7.89-30.11 months). Of these, 28 cases (75.7%) received systemic treatment, 25 cases (67.6%) underwent surgical intervention, and 16 cases (64.0%) received postoperative adjuvant treatment, including combined radiochemotherapy or chemotherapy alone. The median overall survival time was 4 months (0.61-7.40 months) for Group 1 (n = 12), 8 months for Group 2 (n = 2), 21 months (14.67-43.33 months) for Group 3 (n = 4), and 19 months (range 7.89-30.11 months) for Group 4 (n = 19). A significant difference in median overall survival time was observed between Group 1 and Group 4 (P = 0.004).

CONCLUSION

Surgery remains the primary treatment for GB-NEC, with radical resection potentially offering greater benefits to patient survival compared to other therapeutic options. Postoperative adjuvant therapy has the potential to extend patient survival, although the overall prognosis remains challenging.

Primary perihilar bile duct neuroendocrine tumor: a case report and review of the literature

Neuroendocrine tumors represent a rare neoplastic entity, with even rarer occurrences within the biliary tract system. The pathogenesis of such conditions remains enigmatic. Clinical manifestations and radiological evaluations exhibit limited specificity, rendering preoperative diagnoses challenging. As of now, definitive therapeutic modalities remain elusive. Surgical excision stands as the paramount approach for managing biliary neuroendocrine tumors. A thorough preoperative assessment should precede the formulation of a judicious surgical strategy. Postoperative targeted adjuvant therapies hold promise in enhancing therapeutic efficacy and retarding tumor recurrence. This article chronicles a case study detailing a neuroendocrine tumor's diagnostic and treatment course within the perihilar bile duct. Integrating pertinent literature, it encapsulates the clinical attributes and diagnostic and therapeutic advancements in biliary neuroendocrine tumors. The aspiration is to augment awareness of this category of ailments, mitigating the occurrence of both missed and erroneous diagnoses, and furnishing a reference for forthcoming clinical endeavors.

Development and validation of prognostic nomograms in patients with gallbladder mucinous adenocarcinoma: A population-based study

Background

Gallbladder mucinous adenocarcinoma (GBMAC) is an uncommon malignant gallbladder tumor. There are few studies on its prognosis, with the majority consisting of small series or individual cases. We sought to develop and validate nomograms for predicting overall survival (OS) and cancer-specific survival (CSS) in GBMAC patients.

Methods

The clinicopathological data of GBMAC patients from 1975 to 2019 was extracted from the Surveillance, Epidemiology, and End Results (SEER) database, and all patients were randomly divided into a training cohort (70%) and a validation cohort (30%). Using multivariate Cox regression analyses based on Akaike information criterion (AIC), prognostic and important variables for GBMAC were determined. On the basis of these factors, nomograms were developed to predict the 1-, 3-, and 5-year OS and CSS rates of patients with GBMAC. Multiple parameters, including the area under the subject operating characteristic curve (AUC), the calibration plots, and the decision curve analysis (DCA), were then used to evaluate the accuracy of nomograms.

Results

Following exclusion, a total of 707 GBMAC patients were enrolled, and the training cohort (490, 70%) and validation cohort (217, 30%) were randomly assigned. Grade, surgery, radiation, and SEER stage were predictive factors for patients with GBMAC, as indicated by univariate and multivariate Cox regression analyses based on AIC. We created nomograms for predicting OS and CSS in GBMAC using the four factors. The calibration curves and area under the curves (AUCs) indicated that our nomograms have a moderate degree of predictive accuracy and capability. The results of the DCA revealed that the nomogram has a high predictive value.

Conclusion

We established the first nomograms for predicting 1-, 3-, and 5-year OS and CSS in GBMAC patients, thereby contributing to the prognostication of patients and clinical management.

A prognostic nomogram based on log odds of positive lymph nodes to predict the overall survival in biliary neuroendocrine neoplasms (NENs) patients after surgery

BACKGROUND

The prognosis of biliary neuroendocrine neoplasms (NENs) patients is affected by the status of metastatic lymph nodes. The purpose of this study was to explore the prognostic value of the log odds of positive lymph nodes (LODDS) and develop a novel nomogram to predict the overall survival (OS) in biliary NENs patients.

METHODS

A total of 125 patients with histologically confirmed biliary NENs were selected from the Surveillance, Epidemiology and End Results (SEER) database and further divided into training and validation cohorts. The discrimination and calibration of the nomogram were evaluated using the concordance index (C-index), the area under the time-dependent receiver operating characteristic curve (time-dependent AUC), and calibration plots. The net benefits and clinical utility of the nomogram were quantified and compared with those of the SEER staging system using decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI). The risk stratifications of the nomogram and the SEER staging system were compared.

RESULTS

LODDS showed the highest accuracy in predicting OS for biliary NENs. The C-index (0.789 for the training cohort and 0.890 for the validation cohort) and the time-dependent AUC (> 0.7) indicated the satisfactory discriminative ability of the nomogram. The calibration plots showed a high degree of consistency. The DCA, NRI, and IDI indicated that the nomogram performed significantly better than the SEER staging system.

CONCLUSION

A novel LODDS-incorporated nomogram was developed and validated to assist clinicians in evaluating the prognosis of biliary NENs patients.

Cancer-specific survival and metastasis in pancreatic mucinous cystadenocarcinoma: A SEER-based cohort study

Aims

This study aimed to investigate the prognostic value of clinical features for cancer-specific survival (CSS) and metastasis in patients with pancreatic mucinous cystadenocarcinoma (MCAC). We further constructed and validated an effective nomogram to predict CSS.

Methods

We screened patients diagnosed with pancreatic MCAC from Surveillance Epidemiology and End Results (SEER) database. Kaplan-Meier curves were used to determine the CSS time. Univariate and multivariate Cox and logistic regression analyses were conducted to identify the prognostic factors for CSS and metastasis. The nomogram was constructed to predict the prognosis of pancreatic MCAC based on the results from the multivariate analysis. We used the concordance index (C-index), the area under the curve (AUC), and the calibration plots to determine the predictive accuracy and discriminability of the nomogram.

Results

Multivariate Cox analysis revealed that age, primary site, grade, and radiotherapy were independent prognostic factors associated with CSS. Multivariate logistic regression analysis revealed that surgery and grade were independent risk factors associated with metastasis. The independent risk factors were included to construct a prognosis prediction model for predicting CSS in patients with pancreatic MCAC. The concordance index (C-index), receiver operating characteristic (ROC) curves, and calibration plots of the training cohort and the validation cohort showed that the nomogram had an acceptable predictive performance.

Conclusion

We established a nomogram that could determine the 3- and 5-year CSS, which could evaluate individual clinical outcomes and provide individualized clinical decisions.