A Novel Nomogram Predicting Distant Metastasis in T1 and T2 Gallbladder Cancer: A SEER-based Study
A Novel Nomogram Predicting Distant Metastasis in T1 and T2 Gallbladder Cancer: A SEER-based Study
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DOI：
10.7150/ijms.47073
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发表时间：
2020-01-01
影响因子：
3.6
通讯作者：
Cheng, Nan-Sheng
中科院分区：
文献类型：
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作者：
Cai, Yu-Long;Lin, Yi-Xin;Cheng, Nan-Sheng
背景：胆囊癌（GBC）是胆道系统最常见的恶性肿瘤。早期T期GBC伴远处转移者预后较差。在这项研究中，我们的目的是构建和验证一种新的诺模图预测远处转移T1和T2 GBC.Methods：在2004年和2014年之间，T1和T2 GBC患者被确定在监测，流行病学和最终结果（SEER）数据库。所有符合条件的患者被随机分为训练和验证队列。单因素和多因素分析用于评估与远处转移相关的重要预测因素。结果：根据纳入和排除标准，3013例既往确诊为AJCC T1和T2期GBC的患者被纳入研究。年龄小、病理分级高、非腺癌、T1、N1期及肿瘤较大与远处转移风险呈正相关。建立了一种新的诺模图来预测早期T期GBC患者的远处转移。在训练队列中使用校准图的内部验证表明，该列线图校准良好。通过ROC曲线分析，训练队列和验证队列的ROC曲线下面积分别为0.723和0.679。结论：尽管该预测模型存在一定的局限性，但该列线图揭示了T1和T2期GBC患者的临床病理特征与远处转移风险之间的关系。新的列线图将有助于患者咨询和指导T1和T2 GBC患者的治疗决策。
Background: Gallbladder cancer (GBC) is the most common malignancy of the biliary system. Early T stage GBC patients with distant metastasis are proven to have a worse prognosis. In this study, our aim was to construct and validate a novel nomogram for predicting distant metastasis in T1 and T2 GBC.Methods: Between 2004 and 2014, patients with T1 and T2 GBC were identified in the Surveillance, Epidemiology, and End Results (SEER) database. All of the eligible patients were randomly divided into training and validation cohorts. Univariate and multivariate analyses were used to assess significant predictive factors associated with distant metastasis. A nomogram was developed and validated by a calibration curve and receptor operating characteristic curve (ROC) analysis.Results: According to the inclusion and exclusion criteria, 3013 patients with historically confirmed AJCC stage T1 and T2 GBC were enrolled. Younger age, high pathological grade, nonadenocarcinoma, T1, N1 and larger tumor size correlated positively with the risk of distant metastasis. A novel nomogram was established to predict distant metastasis in early T stage GBC patients. Internal validation with a calibration plot in the training cohort showed that this nomogram was well calibrated. Through ROC curve analysis, the areas under the ROC curves in the training and validation cohorts were 0.723 and 0.679, respectively.Conclusions: Although some limitations exist in this predictive model, the nomogram revealed the relationship between the clinicopathological characteristics of T1 and T2 GBC patients and the risk of distant metastasis. The novel nomogram will assist in patient counseling and guide treatment decision making for T1 and T2 GBC patients.