Analysis Of Prognostic Factors In Patients With Gallbladder Cancer After Radical Resection And Construction And Validation Of The Nomogram For Survival Prediction

Background and objective: Gallbladder cancer(GBC)is a highly malignant tumor of the biliary system.The pathogenesis of GBC is related to many factors,and often many patients are in the middle and late stages when diagnosed,with poor prognosis.At present,the treatment of GBC is still very limited.Radical resection is the only way to cure GBC.The prognosis of patients with gallbladder cancer after radical surgery is affected by many factors.The aim of this study is to explore the prognostic factors of patients with GBC after radical resection,and to construct and verify a nomogram model that can predict the prognosis and survival of patients.Methods: The clinical data of patients with GBC who underwent radical resection between 2006 and 2015 were extracted from the Surveillance,Epidemiology,and End Results(SEER)database using SEER*Stat(Version 8.3.9)soft.The clinical data of patients with GBC who underwent radical resection in Anhui Medical University from2015 to 2020 were collected.The data of patients who underwent radical resection of GBC from 2015 to 2020 were collected through the medical record management system of Anhui Provincial Hospital Affiliated to Anhui Medical University and followed up by telephone.According to different center sources,1056 patients extracted from the SEER database were used as the training group,and 76 patients collected from Anhui Medical University Provincial Hospital were used as the validation group.The Kaplan-Meier method was used to analyze the survival of patients in the training group and validation group,and the survival curve was drawn.Univariate Cox analysis was used to screen the risk factors affecting the survival prognosis of patients with gallbladder cancer after radical resection in the training group,and all risk factors were included in multivariate Cox regression analysis to screen the independent risk factors affecting the survival prognosis of patients with gallbladder cancer after radical resection.R software(Version4.2.2)was used to construct1,2,3-year survival nomogram model based on independent risk factors.The Bootstrap method was used for internal validation of the Nomogram,and the external validation of the Nomogram was performed in the validation cohort.The model was evaluated by plotting the receiver operating characteristic curve,1,2,3-year survival rate calibration curve,calculating area under the curve(AUC)and Concordance index(C-index)in the training and validation groups,Results: The median survival time of the training group was 23 months,and the 1-,2-,and 3-year cumulative survival rates were 67.6%,48.8%,and 37.7%,respectively.The median survival time of the validation group was 22 months,and the 1-,2-,and 3-year cumulative survival rates were 69.7%,47.1%,and 41.3%,respectively.Univariate analysis showed that age,tumor diameter,tumor grade,number of positive lymph nodes,number of lymph nodes dissected,TNM stage,T stage,N stage and M stage were related factors affecting the prognosis of patients with GBC after radical resection(P < 0.05).Age,tumor diameter,number of lymph nodes dissected,TNM stage,T stage and N stage were independent risk factors for the prognosis of patients with GBC after radical resection(P < 0.05).The C-index of the model in training group and the validation group were 0.740(95%CI:0.720-0.760)and 0.707(95%CI:0.627-0.787).The AUC at 1,2-,3-year of the training and validation groups were respectively 0.795,0.808,0.812 and 0.792,0.714,0.764.The calibration curve showed that the model prediction had high consistency with the actual survival.Conclusions(1)The malignant degree of GBC is high,and the median survival time of patients after radical resection is less than 2 years.Early diagnosis and early treatment are the key to the treatment of GBC.(2)The prognosis of patients with GBC after radical resection is affected by many factors,among which age,tumor diameter,number of lymph node dissection,TNM stage,T stage and N stage are independent risk factors for postoperative survival.(3)The nomogram model based on SEER database has high accuracy and stability in predicting the survival time of patients with GBC after radical resection,which can provide certain guidance for clinical workers in practice.