Analysis Of Clinical Features And Prognostic Factors In Patients With Hepatic Metastases From Gallbladder Cancer

Background:Globally,gallbladder cancer is a rare but highly malignant tumor of the biliary system.Except for patients with gallbladder cancer that were accidentally discovered during the surgical removal of gallbladder stones or cholecystitis,most patients were in the advanced stage at the time of discovery because of the atypical clinical symptoms,and their prognosis was inferior.Hepatic metastasis is the most common distant metastasis in the pr ogression of gallbladder cancer,and patients with hepatic metastases have lost the best time for surgical resection.Objective: Analyze and explore the clinicopathological factors that affect hepatic metastasis in patients with gallbladder cancer and prog nostic factors that affect the survival of hepatic metastasis in patients with gallbladder cancer.Establish a competitive risk alignment chart to assess risk,quantify survival differences,and provide clinical decisions.Method: This study retrospectively analyzed a total of 2664 gallbladder cancer from January 2010 to December 2015 from the Surveillance,Epidemiology,and EndResults(SEER)database of the National Cancer Institute.Cancer patients,including age,race,gender,tumor size,pathological tissue type,pathological grade,T stage,N stage,and complete clinical information on whether hepatic metastasis occurs,as well as specific survival time and survival status.After applying to obtain relevant data on radiotherapy and chemotherapy in the SEER database,based on the above-mentioned clinical-pathological parameters,the clinical information such as surgical methods,chemotherapy,number of lymph node area dissections,number of lymph node detections,and other organ metastases are included again The final screening of 318 patients with hepatic metastases from gallbladder cancer with complete clinicopathological data was performed.The clinical data of these patients with hepatic metastases from gallbladder cancer were used for survival prognosis analysis.In this study,the χ2 test was used to evaluate whether the clinicopathological parameters affect hepatic metastasis of gallbladder cancer,and independent statistical factors affecting gallbladder cancer were obtained using logistic regression analysis.The Independent prognostic factors were obtained by univariate analysis and multivariate Cox regression analysis,and the independent prognostic indicators were integrated by the visualization of the nomogram.Kaplan-Meier(Log-rank test)was used for survival analysis.The above was statistical analysis in R v3.6 software.Result: A total of 2664 patients with gallbladder cancer were included in the χ2 test,and significant clinical-pathological factors were included in logistic regression.The results showed that the tumor size(OR: 1.006,95% CI: 1.002-1.011,P = 0.003),pathological grade(OR: 1.618,95% CI: 1.267-2.069,P <0.001),T stage(OR: 2.407,95% CI: 1.856-3.135,P <0.001),and N stage(OR: 1.758,95% CI: 1.379-2.238,P <0.001)is an independent influencing factor of hepatic metastasis and a risk factor for hepatic metastasis of gallbladder cancer.Complete prognosis information of 318 patients with hepatic metastases from gallbladder cancer will be analyzed using univariate analysis and multivariate Cox regression analysis.The results showed pathological grade(HR: 1.766,95% CI: 1.352-2.308,P <0.001),surgical method(HR: 0.801,95% CI: 0.691-0.928,P = 0.003),chemotherapy status(HR: 0.342,95% CI: 0.263-0.443,P <0.001)and lymph node detection(HR: 0.788,95% CI: 0.653-0.951,P = 0.013)were independent prognostic factors for overall survival in patients with hepatic metastases from gallbladder cancer.The significant clinical-pathological parameters obtained by multivariate Cox regression analysis were used to establish a nomogram to evaluate the competitive ris k affecting the overall survival and to quantify the difference in survival.By integrating independent prognostic factors,we were able to better demonstrate the contribution of pathological grade,surgical method,chemotherapy status,and lymph node detection to overall survival.Chemotherapy was the most important contributor to survival.The calculated C-index of the nomogram was 7.5,P <0.001,and the calibration curves of 0.5 years,1 year,and 3 years showed that the nomogram had a better predictive ability.Conclusion: 1.Tumor size,pathological grade,T stage,and N stage were independent risk factors affecting hepatic metastasis from gallbladder cancer.2.Univariate and multivariate Cox regression analysis showed that pathological grade,surgical status,lymph node detection,and chemotherapy status were independent prognostic factors affecting patients with hepatic metastases from gallbladder cancer.3.The nomogram of the competitive risk model showed that chemotherapy contributed the most among all independent prognostic factors.Therefore,patients with hepatic metastases from gallbladder cancer still needed active chemotherapy to prolong survival.