Analysis on factors influencing the prognosis of gallbladder cancer patients after radical surgery and construction of a nomo-gram
Objective To analyze the risk factors for poor prognosis of patients with gallbladder cancer(GBC)after receiving radical surgery so as to construct a nomogram to predict the prognosis of patients,providing references for clinic.Methods One hundred and fifty-three patients who underwent radical surgery for GBC from January 1,2011 to January 1,2021 in the First Hospital of Jiaxing were retrospectively selected,and their clinical data were collected,including gender,age,gallbladder stones,tumor size,pathological grading,T stage,nerve infiltration,vascular infiltration,lymph node invasion,margins,glycan antigen 19-9(CA19-9),diabetes mellitus,carcinoembryonic antigen(CEA)and others.Risk factors affecting postoperative overall survival(OS)of GBC patients were analyzed.A visualized nomogram based on risk factors was constructed with the aid of the rms package of R software.Patients were divided by the median score of the constructed nomogram as high prognostic risk group(score ≥157.32)and low prognostic risk group(score＜157.32),and the survival curve was plotted to compare the postoperative survival rates of the two groups.Results The median postoperative survival time of 153 patients was 14.0 months,with an OS of 3.0-60.0 months,and the cumulative overall survival rates at 1,3,and 5 years after surgery of 56.6％,26.5％,and 17.2％,respectively.Multivariate analysis showed that pathological grading(HR=2.44,95％CI:1.074-5.571),nerve infiltration(HR=1.80,95％CI:1.134-2.863),vascular infiltration(HR=3.18,95％CI:1.917-5.264),and T-stage(HR=10.40,95％CI:4.483-24.302),margin(HR=1.97,95％CI:1.102-3.554),and CA19-9(HR=2.12,95％CI:1.174-3.844)were independent risk factors for postoperative OS in patients with GBC(all P＜0.05).The 1-,3-,and 5-year survival rates assessed by the nomogram drawn for predicting postoperative survival of GBC patients were well matched with patients'actual survival.The median score of the nomogram for the 153 GBC patients was 157.32 points.Survival analysis showed that high prognostic risk patients(n=118)had lower 1-,3-,and 5-year OS than low prognostic risk patients(n=35)(27％vs.93％,13％vs.75％,and 9％vs.69％,respectively,all P＜0.05).Conclusion Pathological grading,nerve infiltration,vascular infiltration,T stage,margins,and CA19-9 are independent risk factors for poor prognosis of GBC patients after surgery;the nomogram constructed based on these risk factors can better predict the prognosis of patients,so as to identify patients at high risk of poor prognosis,and benefit clinical decision-making.
万方数据
维普
