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. 2021 May 13;12(14):4172-4182.
doi: 10.7150/jca.49242. eCollection 2021.

Prognostic Value of the Albumin-to-γ-glutamyltransferase Ratio for Gallbladder Cancer Patients and Establishing a Nomogram for Overall Survival

Lejia Sun  1 , Xindi Ke  2 , Dongyue Wang  2 , Huanhuan Yin  2 , Bao Jin  1 , Haifeng Xu  1 , Shunda Du  1 , Yiyao Xu  1 , Haitao Zhao  1 , Xin Lu  1 , Xinting Sang  1 , Shouxian Zhong  1 , Huayu Yang  1 , Yilei Mao  1
Affiliations

Prognostic Value of the Albumin-to-γ-glutamyltransferase Ratio for Gallbladder Cancer Patients and Establishing a Nomogram for Overall Survival

Lejia Sun et al. J Cancer. .

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.

Keywords: albumin-to-γ-glutamyltransferase ratio; gallbladder cancer; nomogram.; prognostic value.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interest exists.

Figures

Figure 1
Figure 1
Kaplan-Meier survival curves for overall survival in gallbladder cancer patients stratified according to AGR. Abbreviations: AGR, albumin-to-γ-glutamyltransferase ratio.
Figure 2
Figure 2
Nomogram based on AGR, T stage, R0 resection, BMI, and CA19-9 for predicting overall survival. Abbreviations: AGR, albumin-to-γ-glutamyltransferase ratio; BMI, body mass index; CA19-9, carbohydrate antigen 19-9.
Figure 3
Figure 3
Calibration curves of the nomogram (red) and the reference model (blue) for 1-, 3- and 5-year overall survival of the training cohort (A-C) and the validation cohort (D-F). The x-axis represents nomogram predicted probability of survival, and the y-axis is the actually observed survival probability.
Figure 4
Figure 4
Time-dependent area under ROC curves of the nomogram (red), the reference model (blue) and the TNM staging system (green) in the training cohort (A) and the validation cohort (B).
Figure 5
Figure 5
Kaplan-Meier survival curves for overall survival in gallbladder cancer patients stratified according to the risk stratification model based on the nomogram.
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References

    1. Rakić M, Patrlj L, Kopljar M, Kliček R, Kolovrat M, Loncar B. et al. Gallbladder cancer. Hepatobiliary surgery and nutrition. 2014;3:221–6. - PMC - PubMed
    1. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clinical epidemiology. 2014;6:99–109. - PMC - PubMed
    1. Chen M, Lin J, Cao J, Zhu H, Zhang B, Wu A. et al. Development and validation of a nomogram for survival benefit of lymphadenectomy in resected gallbladder cancer. Hepatobiliary Surg Nutr. 2019;8:480–9. - PMC - PubMed
    1. Kakaei F, Beheshtirouy S, Nejatollahi SM, Zarrintan S, Mafi MR. Surgical treatment of gallbladder carcinoma: a critical review. Updates in surgery. 2015;67:339–51. - PubMed
    1. de Aretxabala X. Biliary spillage a new prognostic factor in gallbladder cancer? Hepatobiliary surgery and nutrition. 2019;8:537–8. - PMC - PubMed