Construction of a prognostic Nomogram for patients with incidental gallbladder cancer

Abstract

Abstract:

ObjectiveTo construct and validate an effective prognostic nomogram for the patients with incidental gallbladder cancer(IGBC).MethodsThe clinical data of 161 patients with IGBC requiring radical surgery admitted to the First Affiliated Hospital of Xi’an Jiaotong University from May 2011 to October 2022 was analyzed retrospectively. COX proportional risk regression model was used to screen for influencing factors on overall survival(OS) of IGBC. Nomogram was constructed based on independent influencing factors that affected the prognosis of IGBC patients. The concordance index(C-index) and calibration curve were used to validate the performance of the model. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were used to validate the predictive accuracy and net benefit of the plotted column chart.ResultsUnivariate COX regression analysis suggested that age, T stage, N stage, M stage, preoperative carcinoembryonic antigen(CEA), preoperative carbohydrate antigen19-9(CA19-9), preoperative red blood cell volume distribution on width coefficient of variation(RDW-CV), treatment method, and recurrence and metastasis were risk factors which affected the long-term survival of IGBC patients after radical surgery. Multivariate COX regression analysis suggested that T stage, N stage, preoperative CA19-9， preoperative RDW-CV, preoperative AST， treatment methods, and recurrence and metastasis were independent risk factors which affected the prognosis of IGBC patients. The C-index of the constructed prognostic model was 0.872. The calibration plot demonstrated good performance of the Nomogram. ROC curve analysis showed an area under the curve of 0.869, confirming a high sensitivity and specificity. A high net benefit was proven by DCA.ConclusionsThe constructed Nomogram can accurately and intuitively predict the survival probability of IGBC patients after radical surgery.

Key words:Incidental gallbladder cancer,Clinical prediction model,Prognosis,Nomogram

CLC Number:

R735.8

MO Jiantao, CAO Ruiqi, REN Jiaqiang, GENG Zhimin, WU Zheng, CHENG Yali. Construction of a prognostic Nomogram for patients with incidental gallbladder cancer[J]. Journal of Surgery Concepts & Practice, 2024, 29(01): 40-45.

Figures/Tables5

Tab 1

Univariate and multivariate Cox regression analysis of IGBC patients

Variable	Univariate Cox regression analysis		Multivariate Cox regression analysis
Variable	HR(95% CI)	Pvalue	HR(95% CI)	Pvalue
Gender(femalevs.male)	1.40 (0.69-2.80)	0.360
Age(>60vs. ≤60)（year）	1.90 (1.00-3.30)	0.038
Pathological type（othervs.adenocarcinoma）	1.20 (0.28-4.80)	0.830
T(T3+T4vs.T1+T2)	3.70 (1.40-9.70)	0.007	3.10(1.05-9.16)	0.041
N(N1+N2vs.N0)	6.3 0(3.00-13.00)	0.000	3.62(1.29-10.22)	0.015
M(M1vs.M0)	13.00 (5.00-34.00)	0.000
Preoperative AFP(>25vs.≤25)(μg/L)	1.80 (0.24-13.00)	0.57
Preoperative CEA(>5vs.≤5)(μg/L)	5.10 (2.10-13.00)	0.000
Preoperative CA12-5(>35vs.≤35)(μg/L)	1.80 (0.93-3.50)	0.079
Preoperative CA19-9(>37vs.≤37)(μg/L)	6.30 (3.10-12.00)	0.000	15.42(4.75-50.00)	0.000
Preoperative RDW-CV(>14.5vs.≤14.5)	3.00(1.10-8.70)	0.038	3.15(1.04-9.55)	0.043
Preoperative RDW-SD(>56vs.≤56)（fl）	0.00(0-Inf)	1.000
Preoperative ALT(>40vs.≤40)(U/L)	1.40 (0.78-2.60)	0.250
Preoperative AST(>40vs.≤40)(U/L)	1.80 (0.94-3.50)	0.077	0.27(0.08-0.85)	0.025
Preoperative total bilirubin (>17.1vs.≤17.1) (μmol/L)	1.60 (0.80-3.10)	0.190
Preoperative direct bilirubin (>6.8vs.≤6.8) (μmol/L)	1.90 (0.99-3.70)	0.055
Preoperative total protein (>60vs.≤60)(g/L)	0.94 (0.46-1.90)	0.850
Therapy (palliative operationvs.radical operation)	8.30 (4.50-15.00)	0.000	3.35(1.26-8.89)	0.015
Postoperative drainage（Yesvs.No）	1.00(0.47-2.30)	0.910
Recurrence and metastasis(Yesvs.No)	5.50 (3.10-9.80)	0.000	4.51(2.08-9.79)	0.000
Intraoperative bleeding volume (≤500vs.>500)(mL)	0.00(0-Inf)	1.000
Common bile duct diameter (≤1vs.>1)(cm)	0.84 (0.23-3.00)	0.790
Hepatectomy method (othervs.S4b+S5)	0.92 (0.43-2.00)	0.820

Tab 1

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