Incidental gallbladder cancer: a retrospective clinical study of 40 cases

Development and validation of an online dynamic prognostic nomogram for incidental gallbladder adenocarcinoma patients without distant metastasis after surgery: a population-based study

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.

Association of nonsynonymous SNPs of nucleotide excision repair genes ERCC4 rs1800067 (G/A) and ERCC5 rs17655 (G/C) as predisposing risk factors for gallbladder cancer

BACKGROUND

Deregulation of DNA repair mechanisms have been frequently demonstrated in the pathology of cancers including gallbladder cancer.

AIM

We aimed to investigate the association of ERCC4 rs1800067 (G/A) and ERCC5 rs17655 (G/C) with the predisposition in gallbladder cancer and its prognosis. We have also investigated the prognostic and diagnostic values of expression profiles of ERCC4 and ERCC5 in GBC.

METHODS

Polymorphisms of rs1800067 and rs17655 were genotyped by PCR-RFLP. The expression of these genes was analyzed by semi-quantitative PCR. Overall survival was analyzed using Kaplan-Meier plot and cox-regression analysis.

RESULTS

Patients with risk group genotypes of rs17655 have shorter overall survival in patients with presence of gallstone, T1+T2 tumor invasion, absence of lymph node involvement and early stages of tumor. Homozygous wild genotype (GG) of rs1800067 and homozygous mutant genotype (CC) of rs17655 together increases two-fold risk of the disease. The variant genotypes (GC/CC) of rs17655 show significantly higher level of ERCC5 expression.

CONCLUSION

Major allele of ERCC4 rs1800067 and minor allele of ERCC5 rs17655 are significantly associated with increased risk of GBC. Upregulation of ERCC4 and ERCC5 is an early event of development of GBC.