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Tang X, Zheng K, Huang J, Hu W, Xu L, Xu Q, Fan Y, Liu J, Li B, Ran L, Liu T, Liang B, Xiong H, Li W, Fu X, Fang L. Effect of different lymph node dissection methods on the number of lymph nodes detected and prognosis in gallbladder cancer. Medicine (Baltimore) 2023; 102:e34163. [PMID: 37390255 PMCID: PMC10313244 DOI: 10.1097/md.0000000000034163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/09/2023] [Indexed: 07/02/2023] Open
Abstract
At present, the extent of lymph node dissection (LND) for radical gallbladder cancer (GBC) is still controversial, and there is no evidence that LND improves prognosis, however, the latest guidelines for GBC recommend that removal of more than 6 lymph nodes facilitates staging of regional lymph nodes. The aim of this study is to investigate the effect of different LND methods on the number of lymph nodes detected and assess the prognostic factors during radical resection of GBC. This study retrospectively analyzed 133 patients (46 men and 87 women; average age: 64.01, range: 40-83 years) who underwent radical resection of GBC in a single center between July 2017 and July 2022, of which 41 underwent fusion lymph node dissection (FLND) and 92 underwent standard lymph node dissection (SLND). Baseline data, surgical results, number of LNDs, and follow-up data were analyzed. Each patient was followed up every 3 months. The total number of lymph nodes detected after the operation was 12.00 ± 6.95 versus 6.10 ± 4.71 (P < .05). The number of positive lymph nodes detected was (mean) 1.85 versus 0.78 and (percentage) 15.45% versus 12.83% (P < .05). Postoperative complications (8 vs 23, P > .05). The progression-free survival was 13 versus 8 months, the median survival time was 17 versus 9 months (P < .05). This study concluded that FLND can increase the detection rate of total lymph nodes and positive lymph nodes after surgery, which can prolong the survival time of patients.
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Affiliation(s)
- Xinguo Tang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Kangpeng Zheng
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jian Huang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wei Hu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Liangzhi Xu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qi Xu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yuting Fan
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jinghang Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bowen Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Longjian Ran
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Tiande Liu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bo Liang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hu Xiong
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Wen Li
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xiaowei Fu
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Lu Fang
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 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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Wen C, Tang J, Wang T, Luo H. A nomogram for predicting cancer-specific survival for elderly patients with gallbladder cancer. BMC Gastroenterol 2022; 22:444. [PMID: 36324087 PMCID: PMC9632126 DOI: 10.1186/s12876-022-02544-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022] Open
Abstract
Background Gallbladder cancer (GBC) is a highly aggressive malignancy in elderly patients. Our goal is aimed to construct a novel nomogram to predict cancer-specific survival (CSS) in elderly GBC patients. Method We extracted clinicopathological data of elderly GBC patients from the SEER database. We used univariate and multivariate Cox proportional hazard regression analysis to select the independent risk factors of elderly GBC patients. These risk factors were subsequently integrated to construct a predictive nomogram model. C-index, calibration curve, and area under the receiver operating curve (AUC) were used to validate the accuracy and discrimination of the predictive nomogram model. A decision analysis curve (DCA) was used to evaluate the clinical value of the nomogram. Result A total of 4241 elderly GBC patients were enrolled. We randomly divided patients from 2004 to 2015 into training cohort (n = 2237) and validation cohort (n = 1000), and patients from 2016 to 2018 as external validation cohort (n = 1004). Univariate and multivariate Cox proportional hazard regression analysis found that age, tumor histological grade, TNM stage, surgical method, chemotherapy, and tumor size were independent risk factors for the prognosis of elderly GBC patients. All independent risk factors selected were integrated into the nomogram to predict cancer-specific survival at 1-, 3-, and 5- years. In the training cohort, internal validation cohort, and external validation cohort, the C-index of the nomogram was 0.763, 0.756, and 0.786, respectively. The calibration curves suggested that the predicted value of the nomogram is highly consistent with the actual observed value. AUC also showed the high authenticity of the prediction model. DCA manifested that the nomogram model had better prediction ability than the conventional TNM staging system. Conclusion We constructed a predictive nomogram model to predict CSS in elderly GBC patients by integrating independent risk factors. With relatively high accuracy and reliability, the nomogram can help clinicians predict the prognosis of patients and make more rational clinical decisions. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-022-02544-y.
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Affiliation(s)
- Chong Wen
- General Surgery Center, The General Hospital of Western Theater, Chengdu, 610083, Sichuan Province, China.,College of Medicine, Southwest Jiaotong University, Chengdu, China
| | - Jie Tang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenyang Medical College, Shenyang, China
| | - Tao Wang
- General Surgery Center, The General Hospital of Western Theater, Chengdu, 610083, Sichuan Province, China.
| | - Hao Luo
- General Surgery Center, The General Hospital of Western Theater, Chengdu, 610083, Sichuan Province, China.
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Xu X, He M, Wang H, Zhan M, Yang L. Development and validation of a prognostic nomogram for gallbladder cancer patients after surgery. BMC Gastroenterol 2022; 22:200. [PMID: 35448976 PMCID: PMC9026677 DOI: 10.1186/s12876-022-02281-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 04/07/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Gallbladder cancer is associated with late diagnosis and poor prognosis. Current study aims to develop a prognostic nomogram for predicting survival of gallbladder cancer patients after surgery. METHODS Two large cohorts were included in this analysis. One consisted of 1753 gallbladder cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database, and the other consisted of 239 patients from Shanghai Renji hospital. Significant prognostic factors were identified and integrated to develop the nomogram. Then the model was subjected to bootstrap internal validation and external validation. RESULTS Univariate and multivariate analysis indicated that age, tumor histology, T-stage, N-stage and M-stage were significant prognostic factors, which were all included to build the nomogram. The model showed good discrimination, with a concordance index (C-index) of 0.724 (95% CI, 0.708-0.740), and good calibration. Application of the nomogram in the validation cohort still presented good discrimination (C-index, 0.715 [95% CI 0.672-0.758]) and good calibration. In the primary cohort, the C-index of the nomogram was 0.724, which was significantly higher than the Nevin staging system (C-index = 0.671; P < 0.001) and the 8th TNM staging system (C-index = 0.682; P < 0.001). In the validation cohort, the C-index of the nomogram was 0.715, which was also higher than the Nevin staging system (C-index = 0.692; P < 0.05) and the 8th TNM staging system (C-index = 0.688; P = 0.06). CONCLUSIONS The proposed nomogram resulted in more-accurate prognostic prediction for patients with gallbladder cancer after surgery.
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Affiliation(s)
- Xinsen Xu
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Min He
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Hui Wang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Ming Zhan
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China
| | - Linhua Yang
- Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 160 Pujian Road, Shanghai, 200127, People's Republic of China.
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Prognostic factors for recurrence in patients with surgically resected non-small cell lung cancer. Contemp Oncol (Pozn) 2022; 26:239-246. [PMID: 36381667 PMCID: PMC9641628 DOI: 10.5114/wo.2022.120638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 10/02/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Patients with lung cancer receive treatment according to National Cancer Comprehensive Network (NCCN) standards. However, disease recurrence is reported in about 30% of patients during the first five years. Our study aimed to establish independent predictors of lung cancer recurrence. MATERIAL AND METHODS 104 patients with definitive treatment for non-small-cell lung carcinoma receiving standard adjuvant chemotherapy in the period 2014-2018 in our cancer center were retrospectively reviewed. The prognostic significance of five routine immunohistochemical (IHC) markers was examined. RESULTS During the follow-up period disease recurrence occurred in 42 (40.4%) of the 104 enrolled patients. The median recurrence-free survival was 56.3 months, range 4-84.0 months (95% CI = 46.866-65.683). The recurrence-free survival rate was 58.8%. The frequencies of locoregional recurrence, lung recurrence, kidney, bone, lymph nodes of the neck, liver, and brain recurrence were 23.8%, 21.5%, 16.7%, 9.5%, 9.5%, 9.5% and 9.5%, respectively. CONCLUSIONS Using the Cox regression model, category T, histological differentiation, and smoking status were identified as independent predictors of disease recurrence. The studied biological markers (PD-L1, Ki67, p53, epidermal growth factor receptor, and ALK) did not help the model predict disease recurrence. For statistical reliability, it is necessary to conduct a study on a larger cohort of patients and compare the mutual influence of several biomarkers.
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Yang SS, Zhong XH, Wang HX, Min AJ, Wang WM. Nomograms for Predicting Cancer-Specific Survival of Patients with Gingiva Squamous Cell Carcinoma: A Population-Based Study. Curr Med Sci 2021; 41:953-960. [PMID: 34693495 DOI: 10.1007/s11596-021-2435-x] [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: 07/06/2020] [Accepted: 03/29/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVE The use of the traditional American Joint Committee on Cancer (AJCC) staging system alone has limitations in predicting the survival of gingiva squamous cell carcinoma (GSCC) patients. We aimed to establish a comprehensive prognostic nomogram with a prognostic value similar to the AJCC system. METHODS Patients were identified from SEER database. Variables were selected by a backward stepwise selection method in a Cox regression model. A nomogram was used to predict cancer-specific survival rates for 3, 5 and 10 years in patients with GSCC. Several basic features of model validation were used to evaluate the performance of the survival model: consistency index (C-index), receiver operating characteristic (ROC) curve, calibration chart, net weight classification improvement (NRI), comprehensive discriminant improvement (IDI) and decision curve analysis (DCA). RESULTS Multivariate analyses revealed that age, race, marital status, insurance, AJCC stage, pathology grade and surgery were risk factors for survival. In particular, the C-index, the area under the ROC curve (AUC) and the calibration plots showed good performance of the nomogram. Compared to the AJCC system, NRI and IDI showed that the nomogram has improved performance. Finally, the nomogram's 3-year and 5-year and 10-year DCA curves yield net benefits higher than traditional AJCC, whether training set or a validation set. CONCLUSION We developed and validated the first GSCC prognosis nomogram, which has a better prognostic value than the separate AJCC staging system. Overall, the nomogram of this study is a valuable tool for clinical practice to consult patients and understand their risk for the next 3, 5 and 10 years.
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Affiliation(s)
- Si-Si Yang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Xiao-Huan Zhong
- Department of Orthodontics, Center of Stomatology, Xiangya Hospital of Central South University, Changsha, 410008, China
| | - Hui-Xin Wang
- Department of Orthodontics, Center of Stomatology, Xiangya Hospital of Central South University, Changsha, 410008, China
| | - An-Jie Min
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Wei-Ming Wang
- Department of Oral and Maxillofacial Surgery, Center of Stomatology, Xiangya Hospital, Central South University, Changsha, 410008, China.
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A Novel Prognostic Nomogram for Gallbladder Cancer after Surgical Resection: A Single-Center Experience. JOURNAL OF ONCOLOGY 2021; 2021:6619149. [PMID: 34447433 PMCID: PMC8383717 DOI: 10.1155/2021/6619149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 01/16/2021] [Accepted: 01/23/2021] [Indexed: 12/16/2022]
Abstract
Background Gallbladder cancer (GBC), which accounts for more than 80% of biliary tract malignancies, has a poor prognosis with an overall 5-year survival less than 10%. The study aimed to identify risk factors and develop a predictive model for GBC following surgical resection. Methods 98 GBC patients who underwent surgical resection from Guangdong Provincial People's Hospital were enrolled in the study. Cox-regression analysis was performed to identify significant prognostic factors. A nomogram was constructed and Harrell's concordance index, calibration plot, and decision cure analysis were used to evaluate the discrimination and calibration of the nomogram. Results Liver resection, tumor size, perineural invasion, surgical margin, and liver invasion were identified as independent risk factors for overall survival (OS) in GBC patients who underwent surgical resection. Based on the selected risk factors, a novel nomogram was constructed. The C-index of the nomogram was 0.777, which was higher than the American Joint Committee on Cancer (AJCC) staging system (0.724) and Nevin staging system (0.659). Decision cure analysis revealed that the nomogram had a better net benefit and the calibration curves for the 1-, 3-, and 5-year survival probabilities were also well matched with the actual survival rates. Lastly, high-risk GBC were stratified based on the scores of the nomogram and we found high-risk GBC were associated with both worse OS and disease-free survival (DFS). Conclusion We developed a nomogram showing a better predictive capacity for patients' survival of resected GBC than the AJCC staging systems. The established model may help to stratify high-risk GBC and facilitate decision-making in the clinic.
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Zhang H, Ren P, Ma M, Zhu X, Zhu K, Xiao W, Gong L, Tang P, Yu Z. Prognostic Significance of the Preoperative Albumin/Fibrinogen Ratio in Patients with Esophageal Squamous Cell Carcinoma after Surgical Resection. J Cancer 2021; 12:5025-5034. [PMID: 34234871 PMCID: PMC8247378 DOI: 10.7150/jca.58022] [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: 01/10/2021] [Accepted: 06/04/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose: The purpose of the present study was to investigate the prognostic value of inflammatory and nutritional-based scores, including the albumin/fibrinogen ratio (AFR) and albumin/globulin ratio (AGR), in patients with esophageal squamous cell carcinoma (ESCC). Methods: The medical records of 641 patients with resectable ESCC from our institution were retrospectively analyzed. The preoperative AFR and AGR were investigated based on serum albumin, globulin and plasma fibrinogen levels. X-tile software, Kaplan-Meier survival curves and Cox proportional hazard models were performed to identify their prognostic value. The predictive accuracy was evaluated by the concordance index (C-index), calibration plots, and decision curve analysis (DCA). Results: The optimal cutoff values were 15.3 and 1.8 for AFR and AGR, respectively. Univariate survival analysis identified age, smoking history, tumor size, pT status, pN status, NLR, PLR, fibrinogen, albumin, AFR, and AGR as factors associated with overall survival. Multivariate analysis indicated that preoperative AFR (HR: 0.690, 95% CI = 0.495~0.960, P = 0.028), rather than other inflammation- and nutrition-based scores, was an independent predictor of overall survival. The C-index of the predicted nomogram containing AFR (C-index = 0.677) was higher than that of the nomogram without AFR (C-index = 0.656). The calibration curves showed that the predictive abilities were consistent with the actual observation results. Moreover, compared with the traditional staging system, the results of DCA showed that the nomogram had superior predictive ability and higher clinical utility. Conclusion: Our preliminary study suggested that a low preoperative AFR might be a novel and valuable predictor of poor prognosis in patients with ESCC, which may be helpful for prognosis assessment, patient counseling, and therapeutic modality selection.
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Affiliation(s)
- Hongdian Zhang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China
| | - Peng Ren
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China
| | - Mingquan Ma
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China
| | - Xiaolei Zhu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China
| | - Kai Zhu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China
| | - Wanyi Xiao
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China
| | - Lei Gong
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China
| | - Peng Tang
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China
| | - Zhentao Yu
- Department of Esophageal Cancer, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, Tianjin's Clinical Research Center for Cancer, National Clinical Research Center of Cancer, Tianjin 300060, China.,Department of Thoracic Surgery, National Cancer Center, National Clinical Research Center for Cancer, Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and PeKing Union Medical College, Shenzhen 518116, China
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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: 2] [Impact Index Per Article: 0.7] [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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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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12
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Carrasco C, Tittarelli A, Paillaleve N, Pozo MD, Rojas-Sepúlveda D, Barría O, Fluxá P, Hott M, Martin C, Quezada C, Salazar-Onfray F. The Evaluation of 17 Gastrointestinal Tumor Markers Reveals Prognosis Value for MUC6, CK17, and CD10 in Gallbladder-Cancer Patients. Diagnostics (Basel) 2021; 11:diagnostics11020153. [PMID: 33494186 PMCID: PMC7909765 DOI: 10.3390/diagnostics11020153] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 12/28/2022] Open
Abstract
Gallbladder cancer (GBC) is an aggressive and highly lethal disease with relatively low global incidence, but one that constitutes a major health problem in Asian and Latin American countries, particularly in Chile. The identification of new tumor-associated markers with potential prognosis value is required for GBC clinical practice. Using immunohistochemistry/tumor tissue microarray, we evaluated the expression of 17 gastrointestinal tumor-associated protein markers (CK7, CK17, CK19, CK20, CKLMW, CKHMW, MUC1, MUC2, MUC5AC, MUC6, CA125, CD10, CEA, vimentin, villin, claudin-4, and CDX2) in primary gallbladder adenocarcinomas from 180 Chilean patients and analyzed potential associations with their pathological and clinical characteristics. Younger female patients with well- to moderately differentiated tumors had a better prognosis than that of older female or male patients with tumors with a similar tumor differentiation grade. Among all analyzed markers, MUC6 expression was associated with better prognosis in patients with well- to moderately differentiated tumors, whereas CK17 or CD10 was associated with worse prognosis in patients with poorly differentiated tumors. In addition, the MUC6+CK17– expression pattern was strongly associated with better prognosis in patients with well- to moderately differentiated tumors, whereas patients with poorly differentiated tumors and with the CK17+CD10+ expression pattern showed worse prognosis. Our results suggest that tumor MUC6, CK17, and CD10 can be considered as potential prognosis markers for GBC.
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Affiliation(s)
- Cristian Carrasco
- Subdepartamento de Anatomía Patológica, Hospital Base de Valdivia, Valdivia 5090000, Chile; (N.P.); (M.D.P.)
- Correspondence: (C.C.); (F.S.-O.); Tel.: +56-63-2263301 (C.C.); +56-2-29786345 (F.S.-O.)
| | - Andrés Tittarelli
- Programa Institucional de Fomento a la Investigación, Desarrollo e Innovación, Universidad Tecnológica Metropolitana, Santiago 8940577, Chile;
| | - Natalia Paillaleve
- Subdepartamento de Anatomía Patológica, Hospital Base de Valdivia, Valdivia 5090000, Chile; (N.P.); (M.D.P.)
| | - Maeva Del Pozo
- Subdepartamento de Anatomía Patológica, Hospital Base de Valdivia, Valdivia 5090000, Chile; (N.P.); (M.D.P.)
| | - Daniel Rojas-Sepúlveda
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (D.R.-S.); (O.B.); (C.Q.)
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Omar Barría
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (D.R.-S.); (O.B.); (C.Q.)
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
| | - Paula Fluxá
- Departamento de Cirugía Oriente, Facultad de Medicina, Universidad de Chile, Santiago 7500922, Chile;
| | - Melissa Hott
- Subdepartamento de Enfermedades Virales, Instituto de Salud Pública, Santiago 7780050, Chile;
| | - Carolina Martin
- Escuela de Tecnología Médica, Universidad Austral de Chile, Puerto Montt 5500000, Chile;
| | - Claudia Quezada
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (D.R.-S.); (O.B.); (C.Q.)
- Instituto de Bioquímica y Microbiología, Universidad Austral de Chile, Valdivia 5090000, Chile
| | - Flavio Salazar-Onfray
- Millennium Institute on Immunology and Immunotherapy, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile; (D.R.-S.); (O.B.); (C.Q.)
- Disciplinary Program of Immunology, Institute of Biomedical Sciences, Faculty of Medicine, Universidad de Chile, Santiago 8380453, Chile
- Correspondence: (C.C.); (F.S.-O.); Tel.: +56-63-2263301 (C.C.); +56-2-29786345 (F.S.-O.)
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13
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Chen M, Li S, Topatana W, Lv X, Cao J, Hu J, Lin J, Juengpanich S, Shen J, Cai X. Development and Validation of a Nomogram for Predicting Survival in Gallbladder Cancer Patients With Recurrence After Surgery. Front Oncol 2021; 10:537789. [PMID: 33505902 PMCID: PMC7829964 DOI: 10.3389/fonc.2020.537789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The management of gallbladder cancer (GBC) patients with recurrence who need additional therapy or intensive follow-up remains controversial. Therefore, we aim to develop a nomogram to predict survival in GBC patients with recurrence after surgery. METHODS A total of 313 GBC patients with recurrence from our center was identified as a primary cohort, which were randomly divided into a training cohort (N = 209) and an internal validation cohort (N = 104). In addition, 105 patients from other centers were selected as an external validation cohort. Independent prognostic factors, identified by univariate and multivariable analysis, were used to construct a nomogram. The performance of this nomogram was measured using Harrell's concordance index (C-index) and calibration curves. RESULTS Our nomogram was established by four factors, including time-to-recurrence, site of recurrence, CA19-9 at recurrence, and treatment of recurrence. The C-index of this nomogram in the training, internal and external validation cohort was 0.871, 0.812, and 0.754, respectively. The calibration curves showed an optimal agreement between nomogram prediction and actual observation. Notably, this nomogram could accurately stratify patients into different risk subgroups, which allowed more significant distinction of Kaplan-Meier curves than that of using T category. The 3-year post-recurrence survival (PRS) rates in the low-, medium-, and high-risk subgroups from the external validation cohort were 53.3, 26.2, and 4.1%, respectively. CONCLUSION This nomogram provides a tool to predict 1- and 3-year PRS rates in GBC patients with recurrence after surgery.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, China
| | - Shijie Li
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Win Topatana
- Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaozhong Lv
- Department of General Surgery, First People’s Hospital, Mudanjiang, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiahao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jian Lin
- Department of General Surgery, Longyou People’s Hospital, Quzhou, China
| | | | - Jiliang Shen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Zhejiang University School of Medicine, Hangzhou, China
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14
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Yang J, Bao Y, Chen W, Duan Y, Sun D. Nomogram Based on Systemic Immune Inflammation Index and Prognostic Nutrition Index Predicts Recurrence of Hepatocellular Carcinoma After Surgery. Front Oncol 2020; 10:551668. [PMID: 33163397 PMCID: PMC7591400 DOI: 10.3389/fonc.2020.551668] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 09/21/2020] [Indexed: 01/10/2023] Open
Abstract
Background Surgery is a potential cure for hepatocellular carcinoma (HCC), but its postoperative recurrence rate is high, its prognosis is poor, and reliable predictive indicators are lacking. This study was conducted to develop a simple, practical, and effective predictive model. Materials and Methods Preoperative clinical and postoperative pathological data on patients with HCC undergoing partial hepatectomies at the Third Affiliated Hospital of Soochow University from January 2010 to December 2015 were retrospectively analyzed, and a nomogram was constructed. The model performance was evaluated using C-indexes, receiver operating characteristic curves, and calibration curves. The results were verified from validation cohort data collected at the same center from January 2016 to January 2017 and compared with the traditional staging systems. Results Three hundred three patients were enrolled in this study: 238 in the training cohort and 65 in the validation cohort. From the univariate and multivariate Cox regression analyses in the training cohort, six independent risk factors, i.e., age, alpha-fetoprotein (AFP), tumor size, satellite nodules, systemic immune inflammation index (SII), and prognostic nutritional index (PNI), were filtered and included in the nomogram. The C-index was 0.701 [95% confidence interval (CI): 0.654–0.748] in the training cohort and 0.705 (95% CI: 0.619–0.791) in the validation cohort. The areas under the curve for the 1- and 3-year recurrence-free survival were 0.706 and 0.716 in the training cohort and 0.686 and 0.743 in the validation cohort, respectively. The calibration curves showed good agreement. Compared with traditional American Joint Committee on Cancer 8th edition (AJCC8th) and Barcelona Clinic Liver Cancer (BCLC) staging systems, our nomogram showed better predictive ability. Conclusion Our nomogram is simple, practical, and reliable. According to our nomogram, predicting the risk of recurrence and stratifying HCC patient management will yield the greatest survival benefit for patients.
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Affiliation(s)
- Junsheng Yang
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yongjin Bao
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Weibo Chen
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yunfei Duan
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Donglin Sun
- Department of Hepatopancreatobiliary Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
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15
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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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Chen MY, Juengpanich S, Hu JH, Topatana W, Cao JS, Tong CH, Lin J, Cai XJ. Prognostic factors and predictors of postoperative adjuvant transcatheter arterial chemoembolization benefit in patients with resected hepatocellular carcinoma. World J Gastroenterol 2020; 26:1042-1055. [PMID: 32205995 PMCID: PMC7081004 DOI: 10.3748/wjg.v26.i10.1042] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 12/20/2019] [Accepted: 02/09/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postoperative adjuvant transcatheter arterial chemoembolization (PA-TACE) has improved overall survival (OS) in patients with hepatocellular carcinoma (HCC). However, the prognostic and predictive factors remain unclear. AIM To assess the prognostic factors and the predictors of PA-TACE benefit for OS in patients with resected HCC. METHODS Univariate and multivariate analyses were performed to identify the potential prognostic factors for OS. In order to assess the predictive factors of PA-TACE benefit, the interaction variables between treatments for each subgroup were evaluated using the Cox proportional hazards regression model. RESULTS A total of 378 patients (PA-TACE vs surgery alone, 189:189) from three centers were included after a propensity-score 1:1 matching analysis. Compared to the group receiving surgery alone, PA-TACE prolonged the OS rate in patients with resected HCC (P < 0.001). The Barcelona Clinic Liver Cancer system and ferritin-to-hemoglobin ratio (FHR) were used as the prognostic factors for OS in both groups. Age (P = 0.023) and microscopic vascular invasion (MVI) (P = 0.002) were also identified in the PA-TACE group, while gender (P = 0.027), hepatitis B virus (P = 0.034) and albumin-bilirubin grade (P = 0.027) were also selected in the surgery alone group. In addition, PA-TACE resulted in longer OS than surgery alone across subgroups [all hazard ratios (PA-TACE-to-surgery alone) < 1]. Notably, a significantly prolonged OS following PA-TACE was observed in patients with high FHR (P = 0.038) and without MVI (P = 0.048). CONCLUSION FHR and Barcelona Clinic Liver Cancer stages were regarded as prognostic factors for OS. Moreover, high FHR and the absence of MVI were important predictive factors, which can be used to assist clinicians in selecting which patients could achieve a better OS with PA-TACE.
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Affiliation(s)
- Ming-Yu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
- School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
- Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou 310000, Zhejiang Province, China
| | - Sarun Juengpanich
- School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jia-Hao Hu
- School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Win Topatana
- School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Jia-Sheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Chen-Hao Tong
- Department of General Surgery, Shaoxing People’s Hospital, Zhejiang University, Shaoxing 312000, Zhejiang Province, China
| | - Jian Lin
- Department of General Surgery, Longyou People’s Hospital, Quzhou 314400, Zhejiang Province, China
| | - Xiu-Jun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
- School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Chen M, Cao J, Bai Y, Tong C, Lin J, Jindal V, Barchi LC, Nadalin S, Yang SX, Pesce A, Panaro F, Ariche A, Kai K, Memeo R, Bekaii-Saab T, Cai X. Development and Validation of a Nomogram for Early Detection of Malignant Gallbladder Lesions. Clin Transl Gastroenterol 2019; 10:e00098. [PMID: 31663905 PMCID: PMC6884352 DOI: 10.14309/ctg.0000000000000098] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Preoperative decision-making for differentiating malignant from benign lesions in the gallbladder remains challenging. We aimed to create a diagnostic nomogram to identify gallbladder cancer (GBC), especially for incidental GBC (IGBC), before surgical resection. METHODS A total of 587 consecutive patients with pathologically confirmed gallbladder lesions from a hospital were randomly assigned to a training cohort (70%) and an internal validation cohort (30%), with 287 patients from other centers as an external validation cohort. Radiological features were developed by the least absolute shrinkage and selection operator logistic regression model. Significant radiological features and independent clinical factors, identified by multivariate analyses, were used to construct a nomogram. RESULTS A diagnostic nomogram was established by age, CA19.9, and 6 radiological features. The values of area under the curve in the internal and external validation cohorts were up to 0.91 and 0.89, respectively. The calibration curves for probability of GBC showed optimal agreement between nomogram prediction and actual observation. Compared with previous methods, it demonstrated superior sensitivity (91.5%) and accuracy (85.1%) in the diagnosis of GBC. The accuracy using the nomogram was significantly higher in GBC groups compared with that by radiologists in the training cohort (P < 0.001) and similarly in each cohort. Notably, most of the IGBC, which were misdiagnosed as benign lesions, were successfully identified using this nomogram. DISCUSSION A novel nomogram provides a powerful tool for detecting the presence of cancer in gallbladder masses, with an increase in accuracy and sensitivity. It demonstrates an unprecedented potential for IGBC identification.
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Affiliation(s)
- Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Jiasheng Cao
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Yang Bai
- Department of General Surgery, Jinhua Municipal Central Hospital, Jinhua, China
| | - Chenhao Tong
- Department of General Surgery, Shaoxing People's Hospital, Zhejiang University, Shaoxing, China
| | - Jian Lin
- Department of General Surgery, Longyou People's Hospital, Quzhou, China
| | - Vishal Jindal
- Department of Internal Medicine, St. Vincent Hospital, Worcester, Massachusetts, USA
| | - Leandro Cardoso Barchi
- Digestive Surgery Division, Department of Gastroenterology, University of Sao Paulo School of Medicine, São Paulo, Brazil
| | - Silvio Nadalin
- Department of General, Visceral and Transplant Surgery, University Hospital Tuebingen, Tuebingen, Germany
| | - Sherry X. Yang
- National Clinical Target Validation Laboratory, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Antonio Pesce
- Department of Medical and Surgical Sciences and Advanced Technologies “G.F. Ingrassia” Policlinico-Vittorio Emanuele Hospital, Unit of General Surgery, University of Catania, Catania, Italy
| | - Fabrizio Panaro
- Division of Transplantation, Department of General Surgery, University of Montpellier-College of Medicine, Saint Eloi Hospital, Montpellier, France
| | - Arie Ariche
- Department of Surgery, Hadassah Medical Center, Mount Scopus, Jerusalem, Israel
| | - Keita Kai
- Department of Pathology, Saga University Hospital, Saga, Japan
| | - Riccardo Memeo
- Department of Emergency and Organ Transplantation, General Surgery and Transplantation, University Aldo Moro of Bari, Bari, Italy
| | | | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
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