Nomogram construction and validation for predicting the possibility successful implementation of radical surgery in gallbladder cancer patients

doi:10.11958/20231560

Abstract

Abstract:

Objective To develop a nomogram for predicting the successful implementation of radical surgery for gallbladder cancer (GBC). Methods A total of 320 patients with GBC who underwent surgical procedures including radical surgery, palliative excision, abdominal exploration, and biopsy were enrolled in this study. Patients were divided into the training set (235 cases) and the verification set (85 cases) according to the time of inclusion. By comparing the clinical data of patients undergoing radical surgery and patients with non-radical surgery, multivariate Logistic regression analysis was conducted to analyze the prediction model affecting the successful implementation of radical surgery in GBC patients, and a column graph was drawn. Receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the differentiation and calibration of the prediction model. Clinical decision curve (DCA) was used to evaluate the practical utility of the nomogram prediction model. Results Univariate analysis showed that there were significant differences in weight loss, jaundice, hypertension, lymph node metastasis, body mass index (BMI), hemoglobin (HB), albumin (ALB), CA19-9, CA125, total bilirubin and direct bilirubin between the radical surgery group and the non-radical surgery group (P<0.05). These 11 potential predictors were included in the multivariate Logistic regression analysis in the training set, and results showed that no jaundice, hypertension, lymph node metastasis, elevated HB and ALB, and decreased CA19-9 were predictive factors for the successful implementation of radical GBC surgery. A nomogram was established based on 6 independent risk factors obtained by Logistic regression. In the training group and the verification group, the area under the curve of the nomogram was 0.901 and 0.822, respectively, and the model has good differentiation. Hosmer-Lemeshow test showed that the model was well calibrated (χ²=5.740, P=0.676). The calibration curve of the model was close to ideal curve, indicating that the observed results were in good agreement with the actual results. The DCA curve showed that the model had a net benefit and good clinical practicability for clinical application. Conclusion The nomogram can effectively screen patients with GBC suitable for radical surgery, thus reducing the chance of conversion of anticipated radical surgery to palliative resection or exploratory laparotomy and increasing the likelihood of surgical benefits for patients.

Key words: gallbladder neoplasms, nomograms, jaundice, hypertension, CA-19-9 antigen, radical surgery, risk factors

CLC Number:

R735.8

Figures/Tables 7

References 29

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组别	n	手术类型	Tis+T1a	T1b	T2	T3	T4
训练集	235	R0切除	13	14	32	38	4
		姑息性切除	0	0	17	52	13
		腹腔探测或活检	0	0	0	36	16
验证集	85	R0切除	6	8	11	13	1
		姑息性切除	0	0	7	18	4
		腹腔探测或活检	0	0	0	13	4

组别	n	手术类型	Tis+T1a	T1b	T2	T3	T4
训练集	235	R0切除	13	14	32	38	4
		姑息性切除	0	0	17	52	13
		腹腔探测或活检	0	0	0	36	16
验证集	85	R0切除	6	8	11	13	1
		姑息性切除	0	0	7	18	4
		腹腔探测或活检	0	0	0	13	4

变量	β	SE	Wald χ²	P	OR（95%CI）
黄疸	-2.333	0.617	14.301	<0.001	0.097（0.029~0.325）
高血压	-1.135	0.572	3.940	0.047	0.322（0.105~0.986）
淋巴结转移	-1.496	0.553	7.314	0.007	0.224（0.076~0.663）
HB	0.048	0.018	7.415	0.006	1.050（1.014~1.087）
ALB	0.322	0.079	16.590	<0.001	1.380（1.182~1.610）
CA19-9	-0.004	0.001	9.877	0.002	0.996（0.994~0.999）
常数项	-17.713	3.916	20.459	<0.001	0.000

变量	β	SE	Wald χ²	P	OR（95%CI）
黄疸	-2.333	0.617	14.301	<0.001	0.097（0.029~0.325）
高血压	-1.135	0.572	3.940	0.047	0.322（0.105~0.986）
淋巴结转移	-1.496	0.553	7.314	0.007	0.224（0.076~0.663）
HB	0.048	0.018	7.415	0.006	1.050（1.014~1.087）
ALB	0.322	0.079	16.590	<0.001	1.380（1.182~1.610）
CA19-9	-0.004	0.001	9.877	0.002	0.996（0.994~0.999）
常数项	-17.713	3.916	20.459	<0.001	0.000