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. 2021 Jan 11:10:537789.
doi: 10.3389/fonc.2020.537789. eCollection 2020.

Development and Validation of a Nomogram for Predicting Survival in Gallbladder Cancer Patients With Recurrence After Surgery

Mingyu Chen  1   2 , Shijie Li  1 , Win Topatana  3 , Xiaozhong Lv  4 , Jiasheng Cao  1 , Jiahao Hu  1 , Jian Lin  5 , Sarun Juengpanich  3 , Jiliang Shen  1 , Xiujun Cai  1   3
Affiliations

Development and Validation of a Nomogram for Predicting Survival in Gallbladder Cancer Patients With Recurrence After Surgery

Mingyu Chen et al. Front Oncol. .

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.

Keywords: gallbladder cancer; nomogram; prognostic model; recurrence; survival.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of population selection and study design.
Figure 2
Figure 2
Multivariable analysis of the hazard ratio of post-recurrence survival in the training cohort.
Figure 3
Figure 3
A prognostic nomogram for estimating the 1- and 3-year post-recurrence survival rates in the gallbladder cancer patients with recurrence after surgery.
Figure 4
Figure 4
The calibration curves demonstrating how the 1- and 3-year post-recurrence survival predictions from the model compare to the actual observed survival in the (A) training, (B) internal, (C) external validation cohort.
Figure 5
Figure 5
Kaplan-Meier post-recurrence survival curves for each risk subgroup of patients. Patients were stratified by our monogram in the (A) training, (B) internal, (C) external validation cohort. Patients were stratified by the T category in the (D) training, (E) internal, (F) external validation cohort.
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