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. 2022 Apr 21;22(1):200.
doi: 10.1186/s12876-022-02281-2.

Development and validation of a prognostic nomogram for gallbladder cancer patients after surgery

Xinsen Xu #  1 , Min He #  1 , Hui Wang #  1 , Ming Zhan  1 , Linhua Yang  2
Affiliations

Development and validation of a prognostic nomogram for gallbladder cancer patients after surgery

Xinsen Xu et al. BMC Gastroenterol. .

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.

Keywords: Gallbladder cancer; Model; Nomogram; Prognosis.

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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

Fig. 1
Fig. 1
Flowchart showing patient selection process and study workflow
Fig. 2
Fig. 2
Kaplan–Meier survival curves of the gallbladder cancer after surgery. A Survival curves of the SEER cohort; B survival curves stratified by 8th edition AJCC pathologic T category of the SEER cohort; C survival curves stratified by 8th edition AJCC pathologic N category of the SEER cohort; D survival curves stratified by 8th edition AJCC pathologic M category of the SEER cohort; E survival curves of the Renji cohort; F survival curves stratified by 8th edition AJCC pathologic T category of the Renji cohort; G survival curves stratified by 8th edition AJCC pathologic N category of the Renji cohort; H survival curves stratified by 8th edition AJCC pathologic M category of the Renji cohort
Fig. 3
Fig. 3
Developed nomogram for gallbladder cancer survival after surgery. PC papillary carcinoma, AC adenocarcinoma, SC squamous cell carcinoma
Fig. 4
Fig. 4
Calibration curves demonstrating the agreement between the nomogram predicted survival and actual survival, and ROC curves demonstrating the prediction accuracy. A Calibration curves for 1-, 3-, 5-year OS of the SEER cohort; B ROC curves for 1-, 3-, 5-year OS of the SEER cohort; C Calibration curves for 1-, 3-, 5-year OS of the Renji cohort; D ROC curves for 1-, 3-, 5-year OS of the Renji cohort
Fig. 5
Fig. 5
ROC curves comparing the prediction accuracy among the nomogram, Nevin staging system and 8th AJCC TNM staging system. A ROC curves for 1-year OS of the SEER cohort; B ROC curves for 3-year OS of the SEER cohort; C ROC curves for 5-year OS of the SEER cohort; D ROC curves for 1-year OS of the Renji cohort; E ROC curves for 3-year OS of the Renji cohort; F ROC curves for 5-year OS of the Renji cohort
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