Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Oct 27, 2024; 16(10): 3239-3252
Published online Oct 27, 2024. doi: 10.4240/wjgs.v16.i10.3239
Risk factors and survival prediction model establishment for prognosis in patients with radical resection of gallbladder cancer
Xing-Fei Li, Tan-Tu Ma, Tao Li
Xing-Fei Li, Tan-Tu Ma, Tao Li, Department of Hepatobiliary Surgery, Peking University People's Hospital, Peking University, Beijing 100044, China
Author contributions: Li XF designed the research study; Li XF was involved in the analysis and interpretation of the data, and drafted the initial manuscript; Ma TT reviewed relevant literature and data extraction; Li T critically revised the manuscript for important intellectual content.
Supported by Xiao-Ping Chen Foundation for The Development of Science and Technology of Hubei Province, No. CXPJJH122002-061.
Institutional review board statement: The study was reviewed and approved by Peking University People's Hospital. Institutional Review Board, No. 2024PHB310-001.
Informed consent statement: All participants provided informed written consent about personal data collection prior to study enrolment.
Conflict-of-interest statement: The authors declare no conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Tao Li, MD, Chief Doctor, Professor, Department of Hepatobiliary Surgery, Peking University People's Hospital, Peking University, No. 11 Xizhimen South Street, Xichen District, Beijing 100044, China. litao3261@pkuph.edu.cn
Received: July 5, 2024
Revised: August 17, 2024
Accepted: September 6, 2024
Published online: October 27, 2024
Processing time: 84 Days and 20.8 Hours
Abstract
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.

Keywords: Gallbladder cancer radical surgery; Prognosis of gallbladder cancer; Multifactor analysis; Independent risk factors; Nomogram; Survival prediction model

Core Tip: Gallbladder cancer (GBC) is the most prevalent malignant tumor in the biliary system, with curative surgery being the only viable option for long-term survival. Accurate postoperative prognosis assessment is essential for effective treatment planning. Our study identifies lymph node metastasis, tumor differentiation, extrahepatic bile duct invasion, and neural invasion as independent risk factors for postoperative prognosis in GBC patients. we developed a nomogram model that demonstrates strong internal validation consistency.